TB-RNA在肺结核患者抗结核早期疗效评估中的应用价值

doi:10.19982/j.issn.1000-6621.20260192

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (10): 1597-1603.doi: 10.19982/j.issn.1000-6621.20260192

TB-RNA在肺结核患者抗结核早期疗效评估中的应用价值

卢峰岳¹, 苏碧仪², 赵威³, 关平², 朱家楼², 谭耀驹²()

¹ 广州市胸科医院急诊科, 广州 510095
² 广州市胸科医院检验科, 广州 510095
³ 广州市胸科医院结核内科, 广州 510095

收稿日期:2026-04-08 出版日期:2026-10-10 发布日期:2026-09-30
通信作者: 谭耀驹,Email:gzchtan@163.com
基金资助:
广州国家实验室专项(GZNL2024A01030);广州市医学重点学科(2025—2027年,结核病学);广州市科技计划(2023A03J0539);广州市科技计划(2023A03J0991);广州市科技计划(2024B03J1345)

Application value of TB-RNA in early effectiveness evaluation of anti-tuberculosis treatment in patients with pulmonary tuberculosis

Lu Fengyue¹, Su Biyi², Zhao Wei³, Guan Ping², Zhu Jialou², Tan Yaoju²()

¹ Department of Emergency Medicine, Guangzhou Chest Hospital, Guangzhou 510095, China
² Department of Clinical Laboratory, Guangzhou Chest Hospital, Guangzhou 510095, China
³ Department of Tuberculosis Internal Medicine, Guangzhou Chest Hospital, Guangzhou 510095, China

Received:2026-04-08 Online:2026-10-10 Published:2026-09-30
Contact: Tan Yaoju, Email: gzchtan@163.com
Supported by:
Special Project of Guangzhou National Laboratory(GZNL2024A01030);Key Medical Discipline of Guangzhou (Tuberculosis, 2025—2027);Science and Technology Program of Guangzhou(2023A03J0539);Science and Technology Program of Guangzhou(2023A03J0991);Science and Technology Program of Guangzhou(2024B03J1345)

摘要/Abstract

摘要：

目的: 探讨结核分枝杆菌核糖核酸(TB-RNA)检测在肺结核患者抗结核早期疗效评估中的应用价值。方法: 回顾性分析2023年1—12月广州市胸科医院收治的186例经BACTEC MGIT 960液体培养确诊,影像学特征符合活动性肺结核病变表现患者的资料,以治疗满2个月为观察时间点,检测治疗第1、2个月痰液/支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)中TB-RNA和MGIT 960培养结果,分析二者一致性;比较TB-RNA阳性与阴性患者影像学改善差异,采用Spearman等级相关分析研究各变量间的关联性。结果: 入院时TB-RNA阳性率为100.00%(186/186);治疗第1、2个月TB-RNA阳性率分别为53.76%(100/186)、19.35%(36/186),MGIT 960阳性率分别为49.46%(92/186)、18.28%(34/186),均出现了明显降低(TB-RNA:χ²=47.474,P<0.001;MGIT 960:χ²=40.373,P<0.001)。以MGIT 960培养结果为标准,第1个月TB-RNA检测敏感度为93.48%(86/92)、特异度为85.11%(80/94)、Kappa值为0.785;第2个月检测敏感度为88.24%(30/34)、特异度为96.05%(146/152)、Kappa值为0.824。TB-RNA阴性患者有效病灶吸收率及空洞有效闭合率均明显高于阳性患者[第1个月:有效病灶吸收率分别为69.77%(60/86)和40.00%(40/100),空洞有效闭合率分别为27.91%(24/86)和6.00%(6/100);第2个月:有效病灶吸收率分别为86.67%(130/150)和50.00%(18/36),空洞有效闭合率分别为56.00%(84/150)和27.78%(10/36)],差异均有统计学意义(χ²=16.481,P<0.001;χ²=16.403,P<0.001;χ²=24.011,P<0.001;χ²=9.251,P=0.002)。TB-RNA结果与病灶吸收、空洞闭合呈正相关(第1个月:r=0.428,P<0.001;r=0.403,P<0.001;第2个月:r=0.451,P<0.001;r=0.422,P<0.001)。结论: TB-RNA可特异性识别活菌,在抗结核治疗早期(1~2个月)能快速、灵敏反映细菌学转归,与影像学改善高度相关,可作为肺结核早期疗效评估的重要标志物。

关键词: 结核,肺, RNA, 治疗结果, 敏感性与特异性

Abstract:

Objective: To explore the application value of Mycobacterium tuberculosis ribonucleic acid (TB-RNA) detection in evaluating early effectiveness of anti-tuberculosis treatment in patients with pulmonary tuberculosis. Methods: A retrospective analysis was conducted on data of 186 patients admitted to Guangzhou Chest Hospital from January to December 2023, who were diagnosed with pulmonary tuberculosis by BACTEC MGIT 960 liquid culture and had imaging features consistent with active pulmonary tuberculosis lesions. The observation time was 2 months after treatment. TB-RNA test and MGIT 960 culture were performed on sputum/bronchoalveolar lavage fluid (BALF) at the end of 1st and 2nd months of treatment. The consistency between these two tests was analyzed; the differences of imaging improvement between TB-RNA positive and negative patients were compared. The correlations of variables were analyzed using Spearman rank correlation analysis. Results: The positive rate of TB-RNA at admission was 100.00% (186/186); the positive rates of TB-RNA at the end of 1st and 2nd months of treatment were 53.76% (100/186) and 19.35% (36/186), respectively; The positive rates of MGIT 960 were 49.46% (92/186) and 18.28% (34/186), respectively, both showing a downward trend (TB-RNA: χ²=47.474, P<0.001; MGIT 960: χ²=40.373, P<0.001). Using MGIT 960 result as standard, the sensitivity of TB-RNA detection in the 1st month was 93.48% (86/92), the specificity was 85.11% (80/94), and the Kappa value was 0.785; the sensitivity in the 2nd month was 88.24% (30/34), the specificity was 96.05% (146/152), and the Kappa value was 0.824. The effective lesion absorption rate and cavity closure rate of TB-RNA-negative patients were significantly higher than those of TB-RNA-positive patients (effective lesion absorption rate at the 1st month: 69.77% (60/86) vs. 40.00% (40/100), cavity closure rate: 27.91% (24/86) vs. 6.00% (6/100); effective lesion absorption rate at the 2nd month: 86.67% (130/150) vs. 50.00% (18/36), cavity closure rate: 56.00% (84/150) vs. 27.78% (10/36); χ²=16.481, 16.403, 24.011, 9.251, P<0.001, <0.001, <0.001, 0.002); The TB-RNA results were positively correlated with lesion absorption and cavity closure (r=0.428, 0.403 at the 1st month, r=0.451, 0.422 at the 2nd month, all P<0.001). Conclusion: TB-RNA can specifically identify viable bacteria, rapidly and sensitively reflects bacteriological outcome at the early stage of anti-tuberculosis treatment (1-2 months), and is highly correlated with imaging improvement, which can be used as an important marker for the early effectiveness evaluation of pulmonary tuberculosis.

Key words: Tuberculosis, pulmonary, RNA, Treatment outcome, Sensitivity and specificity

中图分类号:

R521

卢峰岳, 苏碧仪, 赵威, 关平, 朱家楼, 谭耀驹. TB-RNA在肺结核患者抗结核早期疗效评估中的应用价值[J]. 中国防痨杂志, 2026, 48(10): 1597-1603. doi: 10.19982/j.issn.1000-6621.20260192

Lu Fengyue, Su Biyi, Zhao Wei, Guan Ping, Zhu Jialou, Tan Yaoju. Application value of TB-RNA in early effectiveness evaluation of anti-tuberculosis treatment in patients with pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(10): 1597-1603. doi: 10.19982/j.issn.1000-6621.20260192

图/表 3

表1

表2

表3

参考文献 17

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指标	分级	随访第1个月		随访第2个月
指标	分级	TB-RNA阳性 (100例)	TB-RNA阴性 (86例)	TB-RNA阳性 (36例)	TB-RNA阴性 (150例)
病灶吸收	明显吸收	8(8.00)	20(23.26)	6(16.67)	60(40.00)
	吸收	32(32.00)	40(46.51)	12(33.33)	70(46.67)
	无变化	52(52.00)	24(27.91)	16(44.44)	19(12.67)
	恶化	8(8.00)	2(2.32)	2(5.56)	1(0.67)
Z值		4.344		4.269
P值		<0.001		<0.001
空洞变化	闭合	2(2.00)	10(11.63)	4(11.11)	39(26.00)
	缩小	4(4.00)	14(16.28)	6(16.67)	45(30.00)
	无变化	86(86.00)	57(66.28)	24(66.67)	61(40.67)
	增大	8(8.00)	5(5.81)	2(5.56)	5(3.33)
Z值		3.557		2.915
P值		<0.001		0.004

TB-RNA在肺结核患者抗结核早期疗效评估中的应用价值

Application value of TB-RNA in early effectiveness evaluation of anti-tuberculosis treatment in patients with pulmonary tuberculosis

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随访时间	TB-RNA 检测	MGIT 960培养		合计
随访时间	TB-RNA 检测	阳性	阴性	合计
第1个月	阳性	86	14	100
	阴性	6	80	86
	合计	92	94	186
第2个月	阳性	30	6	36
	阴性	4	146	150
	合计	34	152	186

项目	随访时间	病灶吸收等级		空洞变化等级
项目	随访时间	r值	P值	r值	P值
TB-RNA	第1个月	0.428	<0.001	0.403	<0.001
MGIT 960培养	第1个月	0.396	<0.001	0.371	<0.001
TB-RNA	第2个月	0.451	<0.001	0.422	<0.001
MGIT 960培养	第2个月	0.422	<0.001	0.388	<0.001

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