Xpert® MTB/RIF assay 在支气管灌洗液快速诊断支气管结核中的应用

Performance of the Xpert® MTB/RIF assay in the rapid diagnosis of tracheobronchial tuberculosis using bronchial washing fluid.

机构信息

Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China.

Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.

出版信息

J Int Med Res. 2020 Oct;48(10):300060520921640. doi: 10.1177/0300060520921640.

DOI:10.1177/0300060520921640

PMID:33045875

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7557701/

Abstract

OBJECTIVE

To assess the diagnostic value of the Xpert® MTB/RIF (GeneXpert) assay for tracheobronchial tuberculosis (TBTB) using bronchial washing fluid (BWF).

METHODS

This retrospective study enrolled patients suspected of having TBTB and patients with non-TB pulmonary disease as controls. BWF were used to undertake acid-fast bacillus (AFB) smears, the GeneXpert assay and the Lӧwenstein-Jensen (LJ) culture method. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared among BWF AFB smears, BWF GeneXpert and the BWF LJ culture method.

RESULTS

A total of 130 patients with TBTB and 102 patients with non-TB pulmonary disease were enrolled in the study. Sputum AFB smears were positive in 62 of 130 patients (47.7%) with TBTB. Using the clinical diagnosis of TBTB as the gold standard, the sensitivity, specificity, PPV and NPV of the three methods using BWF were as follows: 93.1%, 99.0%, 99.2% and 91.8% for BWF GeneXpert; 73.1%, 100.0%, 100.0% and 74.5% for BWF LJ cultures; 53.8%, 99.0%, 98.6% and 62.7% for BWF AFB smears. The diagnostic yield of BWF GeneXpert was significantly higher compared with BWF cultures for type III and IV TBTB.

CONCLUSION

The Xpert® MTB/RIF assay using BWF exhibited higher sensitivity than bacteriological diagnostic methods and was particularly useful for the early diagnosis of smear-negative TBTB.

摘要

目的

评估支气管灌洗液（BWF）中 Xpert® MTB/RIF（GeneXpert）检测在气管支气管结核（TBTB）中的诊断价值。

方法

本回顾性研究纳入疑似 TBTB 患者和非结核肺部疾病患者作为对照。使用 BWF 进行抗酸杆菌（AFB）涂片、GeneXpert 检测和 Löwenstein-Jensen（LJ）培养。比较 BWF AFB 涂片、BWF GeneXpert 和 BWF LJ 培养的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。

结果

共纳入 130 例 TBTB 患者和 102 例非结核肺部疾病患者。130 例 TBTB 患者中有 62 例（47.7%）痰 AFB 涂片阳性。以 TBTB 的临床诊断为金标准，BWF 三种方法的敏感性、特异性、PPV 和 NPV 如下：BWF GeneXpert 为 93.1%、99.0%、99.2%和 91.8%；BWF LJ 培养为 73.1%、100.0%、100.0%和 74.5%；BWF AFB 涂片为 53.8%、99.0%、98.6%和 62.7%。BWF GeneXpert 的诊断检出率明显高于 BWF 培养的 III 型和 IV 型 TBTB。