引用本文:赵 丽,胡黎梅,袁育林,梁 亮,蒋 洁.涂片抗酸染色T-SPOT.TB与GeneXpert MTB/RIF联合检测在结核病诊断中的应用价值分析[J].中国临床新医学,2022,15(10):928-932.
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涂片抗酸染色T-SPOT.TB与GeneXpert MTB/RIF联合检测在结核病诊断中的应用价值分析
赵 丽,胡黎梅,袁育林,梁 亮,蒋 洁
530021 南宁,广西壮族自治区人民医院(广西医学科学院)检验科
摘要:
[摘要] 目的 分析涂片抗酸染色(涂片法)、结核感染T细胞斑点试验(T-SPOT.TB)、结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术(GeneXpert MTB/RIF)三种方法联合检测在结核病诊断中的应用价值。方法 回顾性分析2021年12月至2022年9月在广西壮族自治区人民医院同时进行涂片法、T-SPOT.TB、GeneXpert MTB/RIF检测的临床疑诊结核分枝杆菌感染患者的检测结果,以临床确诊结果为“金标准”计算上述三种方法及其中两者联合检测的灵敏度、特异度、阳性预测值、阴性预测值、准确率。分析三种检测方法单独和联合检测对结核病的诊断价值。结果 298例疑似结核患者中,排除31例,最终临床确诊为结核74例,非结核193例。涂片法、T-SPOT.TB、GeneXpert MTB/RIF检测的灵敏度分别为43.2%、94.6%、63.5%,比较差异有统计学意义(χ2=44.861,P=0.000);T-SPOT.TB检测特异度低于涂片法和GeneXpert MTB/RIF,差异有统计学意义(χ2=74.861,P=0.000; χ2=78.162,P=0.000);三种方法检测准确率比较差异有统计学意义(χ2=23.468,P=0.000)。涂片法联合T-SPOT.TB检测的灵敏度与涂片法相比,差异有统计学意义(χ2=45.548,P=0.000)。涂片法联合GeneXpert MTB/RIF检测的灵敏度与涂片法相比,差异有统计学意义(χ2=6.965,P=0.008)。结论 在结核病诊断中,GeneXpert MTB/RIF和涂片法的准确率比T-SPOT.TB高,T-SPOT.TB或GeneXpert MTB/RIF的检测灵敏度显著高于涂片法。采用T-SPOT.TB或GeneXpert MTB/RIF联合涂片法均可显著提高结核病诊断的灵敏度,推荐采用联合检测方法以提高临床诊断效能。
关键词:  结核病  涂片法  结核感染T细胞斑点试验  结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术
DOI:10.3969/j.issn.1674-3806.2022.10.07
分类号:R 446;R 52
基金项目:广西卫生健康委科研课题(编号:Z2015329,Z20210687)
Analysis on the application value of the combined detection of acid fast bacteria stain, T-SPOT.TB and GeneXpert MTB/RIF in diagnosis of tuberculosis
ZHAO Li, HU Li-mei, YUAN Yu-lin, et al.
Department of Laboratory Medicine, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021,China
Abstract:
[Abstract] Objective To analyse the application value of the combined detection of the three methods of acid fast bacteria stain(smear method), T-cell spot of tuberculosis assay(T-SPOT.TB) and GeneXpert MTB/RIF in diagnosis of tuberculosis. Methods The results of the smear method, T-SPOT.TB and GeneXpert MTB/RIF were retrospectively analyzed in the patients with clinically suspected Mycobacterium tuberculosis infection who were admitted to the People′s Hospital of Guangxi Zhuang Autonomous Region from December 2021 to September 2022 and received the detection of Mycobacterium tuberculosis by using the three methods at the same time. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of the above three methods and the joint detection of the two of the three methods were calculated by using the clinical diagnosis results as the gold standard. The diagnostic value of single and combined detection of the three detection methods in tuberculosis was analyzed. Results Of the 298 suspected tuberculosis patients, 74 patients were clinically diagnosed as tuberculosis in the end and 193 patients as non-tuberculosis, and 31 patients were excluded. The detection sensitivity of the smear method, T-SPOT.TB and GeneXpert MTB/RIF was 43.2%, 94.6% and 63.5%, respectively, and the difference was statistically significant among the three detection methods(χ2=44.861, P=0.000). The detection specificity of T-SPOT.TB was lower than that of the smear method and GeneXpert MTB/RIF, and the differences were statistically significant(χ2=74.861, P=0.000; χ2=78.162, P=0.000). There was a statistically significant difference in the detection accuracy rate among the three methods(χ2=23.468, P=0.000). There was a statistically significant difference in the detection sensitivity between the smear method combined with T-SPOT.TB and the smear method(χ2=45.548, P=0.000). There was a statistically significant difference in the detection sensitivity between the smear method combined with GeneXpert MTB/RIF and the smear method(χ2=6.965, P=0.008). Conclusion In the diagnosis of tuberculosis, the accuracy rates of GeneXpert MTB/RIF and the smear method are higher than the accuracy rate of T-SPOT.TB. The detection sensitivity of T-SPOT.TB or GeneXpert MTB/RIF is significantly higher than that of the smear method. Using T-SPOT. TB or GeneXpert MTB/RIF combined with the smear method can significantly improve the sensitivity of the diagnosis of tuberculosis. The combined detection methods are recommended to improve the efficiency of the clinical diagnosis of tuberculosis.
Key words:  Tuberculosis  Smear method  T-cell spot of tuberculosis assay(T-SPOT.TB)  GeneXpert MTB/RIF