Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China.
Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China.
J Int Med Res. 2020 Oct;48(10):300060520921640. doi: 10.1177/0300060520921640.
To assess the diagnostic value of the Xpert® MTB/RIF (GeneXpert) assay for tracheobronchial tuberculosis (TBTB) using bronchial washing fluid (BWF).
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.
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.
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.
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。
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）。
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。
BWF 中 Xpert® MTB/RIF 检测的敏感性高于细菌学诊断方法，尤其对阴性涂片 TBTB 的早期诊断有用。
