舌拭子核酸检测在疑似肺结核诊断中的应用价值

doi:10.19982/j.issn.1000-6621.20260109

中国防痨杂志 ›› 2026, Vol. 48 ›› Issue (8): 1163-1169.doi: 10.19982/j.issn.1000-6621.20260109

舌拭子核酸检测在疑似肺结核诊断中的应用价值

齐云峰¹, 王雪钰², 康万里³(), 聂文娟²(), 王一文¹^,²()

¹ 河南省周口市传染病医院/周口市结核病防治所结核科, 周口 466000
² 首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所结核一科, 北京 101149
³ 首都医科大学附属北京胸科医院/北京市结核病胸部肿瘤研究所流行病学研究室, 北京 101149

收稿日期:2026-02-27 出版日期:2026-08-01 发布日期:2026-07-30
通信作者: 王一文,Email:18738890153@163.com;聂文娟,Email:wenjuan.nie@outlook.com;康万里,Email:kangwlcch@163.com
基金资助:
北京市卫健委研究型病房卓越临床研究计划(BRWEP2024W042160100);北京市卫生健康委员会登峰项目(G202511062)

The application value of tongue swab nucleic acid testing in the diagnosis of suspected tuberculosis

Qi Yunfeng¹, Wang Xueyu², Kang Wanli³(), Nie Wenjuan²(), Wang Yiwen¹^,²()

¹ Department of Tuberculosis, Zhoukou Infectious Disease Hospital, Zhoukou Tuberculosis Control and Prevention Institute, Henan Province, Zhoukou 466000, China
² Department Ⅰ of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
³ Epidemiology Research Office, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China

Received:2026-02-27 Online:2026-08-01 Published:2026-07-30
Contact: Wang Yiwen, Email: 18738890153@163.com; Nie Wenjuan, Email: wenjuan.nie@outlook.com; Kang Wanli, Email: kangwlcch@163.com
Supported by:
Beijing Municipal Health Commission Excellent Clinical Research Program for Research-Oriented Wards(BRWEP2024W042160100);Beijing Municipal Health Commission Dengfeng Program(G202511062)

摘要/Abstract

摘要：

目的: 评估舌拭子核酸检测技术(简称“舌拭子”)在疑似肺结核诊断中的应用价值。方法: 采用前瞻性研究方法,于2025年10—12月连续纳入河南省周口市传染病医院入院诊治的176例疑似肺结核患者作为研究对象,参照排除标准最终纳入106例患者进行分析,分别进行舌拭子、MGIT 960液体培养(简称“MGIT 960”)、GeneXpert MTB/RIF(简称“Xpert”)、痰涂片抗酸染色法(简称“痰涂片”)检测,评估4种方法的检测效能。结果: 106例疑似患者中,确诊肺结核85例(80.19%),非确诊肺结核21例(19.81%)。舌拭子、MGIT 960、Xpert及痰涂片对106例疑似患者的检测阳性率分别为50.00%(53例)、50.00%(53例)、59.43%(63例)、40.57%(43例)。以确诊肺结核为参照标准,舌拭子检测的敏感度[61.18%(52/85)]与MGIT 960[62.35%(53/85)]基本相当,高于痰涂片[50.59%(43/85)],但低于Xpert[74.12%(63/85)];特异度[95.24%(20/21)]和准确率[67.92%(72/106)]均与MGIT 960[分别为100.00%(21/21)和69.81%(74/106)]、Xpert[分别为100.00%(21/21)和79.25%(84/106)]及痰涂片[分别为100.00%(21/21)和60.38%(64/106)]基本相当;受试者工作特征曲线下面积(AUC)为0.782,低于Xpert(0.871;Z=-2.686,P=0.007),但与MGIT 960(0.812;Z=-0.870,P=0.384)和痰涂片(0.753;Z=0.853,P=0.394)基本一致;与痰涂片显示出优秀的一致性(Kappa=0.774,95%CI:0.655~0.892),与MGIT 960及Xpert均显示出较好的一致性(Kappa=0.736,95%CI:0.607~0.865;Kappa=0.736,95%CI:0.609~0.862)。结论: 舌拭子检测在疑似肺结核诊断中具有良好的临床应用价值,可作为肺结核筛查和辅助诊断的有效手段,尤其适用于痰液获取困难或无法留取痰标本的患者群体。

关键词: 结核,肺, 舌拭子, 聚合酶链反应, 评价研究

Abstract:

Objective: To evaluate the diagnostic value of tongue swab nucleic acid detection (tongue swab) in suspected pulmonary tuberculosis patients. Methods: A prospective study was conducted from October to December 2025. A total of 176 patients with suspected pulmonary tuberculosis who were admitted to Zhoukou Infectious Disease Hospital, Henan Province, were consecutively enrolled. According to the exclusion criteria, 106 suspected cases were included and subjected to tongue swab, MGIT 960 liquid culture (MGIT 960), GeneXpert MTB/RIF (Xpert), and sputum smear acid-fast staining (sputum smear) to evaluate the diagnostic efficacy of these four methods. Results: Among the 106 suspected cases, 85 (80.19%) were confirmed as pulmonary tuberculosis, and 21 (19.81%) were non pulmonary tuberculosis. The positive detection rates for tongue swab, MGIT 960, Xpert, and sputum smear among these 106 suspected cases were 50.00% (53/106), 50.00% (53/106), 59.43% (63/106), and 40.57% (43/106), respectively. Using confirmed pulmonary tuberculosis as reference standard, the sensitivity of tongue swab (61.18% (52/85)) was comparable to that of MGIT 960 (62.35% (53/85)), higher than that of sputum smear (50.59% (43/85)), but lower than that of Xpert (74.12% (63/85)). The specificity (95.24% (20/21)) and accuracy (67.92% (72/106)) of tongue swab were comparable to those of MGIT 960 (100.00% (21/21) and 69.81% (74/106), respectively), Xpert (100.00% (21/21) and 79.25% (84/106), respectively), and sputum smear (100.00% (21/21) and 60.38% (64/106), respectively). The area under the receiver operating characteristic curve (AUC) of tongue swab was 0.782, which was lower than that of Xpert (0.871; Z=-2.686, P=0.007), but comparable to those of MGIT 960 (0.812; Z=-0.870, P=0.384) and sputum smear (0.753; Z=0.853, P=0.394). Tongue swab showed excellent agreement with sputum smear (Kappa=0.774, 95%CI: 0.655-0.892), and good agreement with both MGIT 960 (Kappa=0.736, 95%CI: 0.607-0.865) and Xpert (Kappa=0.736, 95%CI: 0.609-0.862). Conclusion: Tongue swab demonstrates favorable clinical application value in the diagnosis of pulmonary tuberculosis. It can serve as an effective tool for tuberculosis screening and auxiliary diagnosis, particularly for patients with difficulty in sputum expectoration or inability to provide sputum specimens.

Key words: Tuberculosis, pulmonary, Tongue swab, Polymerase chain reaction, Evaluation studies

中图分类号:

R521

齐云峰, 王雪钰, 康万里, 聂文娟, 王一文. 舌拭子核酸检测在疑似肺结核诊断中的应用价值[J]. 中国防痨杂志, 2026, 48(8): 1163-1169. doi: 10.19982/j.issn.1000-6621.20260109

Qi Yunfeng, Wang Xueyu, Kang Wanli, Nie Wenjuan, Wang Yiwen. The application value of tongue swab nucleic acid testing in the diagnosis of suspected tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(8): 1163-1169. doi: 10.19982/j.issn.1000-6621.20260109

图/表 4

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特征	合计(106例)	确诊肺结核(85例)	非确诊肺结核(21例)	统计检验值	P值
性别[例(构成比,%)]				χ²=0.231	0.631
男性	80(75.47)	65(76.47)	15(71.43)
女性	26(24.53)	20(23.53)	6(28.57)
年龄[岁,M(Q₁,Q₃)]	68.0(57.0,77.0)	67.0(56.5,77.0)	74.0(58.5,80.0)	U=746.000	0.245
症状[例(发生率,%)]
发热	54(50.94)	45(52.94)	9(42.86)	χ²=0.685	0.408
咯血	19(17.92)	15(17.65)	4(19.05)	-	0.999
胸痛	7(6.60)	7(8.24)	0(0.00)	-	0.340
咳嗽	92(86.79)	73(85.88)	19(90.48)	-	0.732

检测方法	肺结核(例)		敏感度 (%,95%CI)	特异度 (%,95%CI)	阳性预测值 (%,95%CI)	阴性预测值 (%,95%CI)	准确率 (%,95%CI)	AUC (95%CI)
检测方法	确诊	非确诊	敏感度 (%,95%CI)	特异度 (%,95%CI)	阳性预测值 (%,95%CI)	阴性预测值 (%,95%CI)	准确率 (%,95%CI)	AUC (95%CI)
舌拭子			61.18 (50.55~70.84)	95.24 (77.33~99.15)	98.11 (90.06~99.67)	37.74 (25.94~51.19)	67.92 (58.55~76.05)	0.782 (0.689~0.875)
阳性	52	1
阴性	33	20
MGIT 960			62.35 (51.73~71.91)	100.00 (84.54~100.00)	100.00 (93.24~100.00)	39.62 (27.59~53.06)	69.81 (60.52~77.74)	0.812 (0.732~0.891)
阳性	53	0
阴性	32	21
Xpert			74.12 (63.91~82.24)	100.00 (84.54~100.00)	100.00 (94.25~100.00)	48.84 (34.62~63.25)	79.25 (70.57~85.88)	0.871 (0.805~0.936)
阳性	63	0
阴性	22	21
痰涂片			50.59 (40.17~61.96)	100.00 (84.54~100.00)	100.00 (91.80~100.00)	33.33 (22.95~45.63)	60.38 (50.86~69.17)	0.753 (0.661~0.845)
阳性	43	0
阴性	42	21

舌拭子核酸检测在疑似肺结核诊断中的应用价值

The application value of tongue swab nucleic acid testing in the diagnosis of suspected tuberculosis

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参考文献 24

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Xpert结果				痰涂片结果
方法/分级	计数	与舌拭子一致例数	一致率(%)	方法/分级	计数	与舌拭子一致例数	一致率(%)
Xpert				痰涂片
高	21	21	100.00	++++	2	2	2/2
中	10	10	100.00	+++	1	1	1/1
低	23	17	73.91	++	17	17	100.00
极低	7	3	3/7	+	23	22	96.65
卡痕	2	0	0/2	阳性小计	43	42	97.67
阴性	43	41	95.35	阴性	63	11	17.46
合计	106	92	86.79	合计	106	53	50.00

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