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

doi:10.19982/j.issn.1000-6621.20260109

Abstract

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

CLC Number:

R521

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

Figures/Tables 4

References 24

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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

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