Department of Pleurisy, Shenyang Tenth People's Hospital and Shenyang Chest Hospital, Shenyang, Liaoning Province, 110044, People's Republic of China.
Department of Thoracic Surgery, Shenyang Tenth People's Hospital and Shenyang Chest Hospital, Shenyang, Liaoning Province, 110044, People's Republic of China.
BMC Infect Dis. 2020 Nov 12;20(1):840. doi: 10.1186/s12879-020-05578-3.
Etiological diagnosis of tuberculous pleuritis is challenging, owing to a paucity of Mycobacterium tuberculosis (MTB) in the affected region. Moreover, currently available methods, such as the detection of acid-fast bacilli and microbiological culture, are not always conducive to timely diagnosis and treatment. In this study, we evaluated the performance of Xpert® MTB/RIF assay (hereinafter referred to as "Xpert") in detecting MTB in difficult-to-diagnose patients using suspensions of pleural biopsy tissue specimens obtained under direct thoracoscopic guidance.
One hundred and sixty patients with an unexplained pleural effusion were included from the Shenyang Tenth People's Hospital and Shenyang Chest Hospital, China, between 2017 and 2018. The included patients underwent thoracoscopy under local anesthesia, with an intercostal incision of approximately 1.0 cm for biopsy. The biopsy specimens were used for pathological and etiological examinations. The Xpert test was evaluated for its sensitivity and specificity, as well as positive and negative predictive values (PPV and NPV, respectively), against data obtained using standards: the BACTEC™ MGIT™ 960 liquid culture system and a composite reference standard (CRS).
The sensitivity and specificity of Xpert were 68.8 and 64.6%, respectively, against the MGIT 960 culture data. The PPV and NPV of Xpert were 56.4 and 75.6%, respectively. The sensitivity of Xpert was 69.0% against the CRS data, which was significantly higher than that of MGIT 960 culture (56.6%). The PPV and NPV of Xpert against the CRS data were 100.0 and 57.3%, respectively.
Xpert is a good rule-in test but has limited value as a rule-out test for the diagnosis of tuberculosis pleuritis.
由于受累区域结核分枝杆菌（MTB）含量较少，结核性胸膜炎的病因诊断具有挑战性。此外，目前可用的方法，如抗酸杆菌检测和微生物培养，并不总是有利于及时诊断和治疗。在本研究中，我们评估了 Xpert® MTB/RIF 检测（简称“Xpert”）在直接胸腔镜引导下获取的胸膜活检组织悬液中检测 MTB 的性能，这些患者的诊断较为困难。
2017 年至 2018 年，我们纳入了来自中国沈阳第十人民医院和沈阳胸科医院的 160 例不明原因胸腔积液患者。这些患者在局部麻醉下接受胸腔镜检查，采用约 1.0cm 的肋间切口进行活检。活检标本用于病理和病因检查。我们评估了 Xpert 检测的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），并将其与 BACTEC™ MGIT™ 960 液体培养系统和综合参考标准（CRS）的数据进行了比较。
Xpert 检测对 MGIT 960 培养数据的敏感性和特异性分别为 68.8%和 64.6%。Xpert 检测的 PPV 和 NPV 分别为 56.4%和 75.6%。Xpert 检测对 CRS 数据的敏感性为 69.0%，明显高于 MGIT 960 培养（56.6%）。Xpert 检测对 CRS 数据的 PPV 和 NPV 分别为 100.0%和 57.3%。
Xpert 是一种良好的确诊试验，但作为结核性胸膜炎的排除性诊断试验，其价值有限。
