抗酸染色联合 GeneXpert MTB/RIF 在非结核分枝杆菌肺病诊断中的应用。
Application of acid-fast staining combined with GeneXpert MTB/RIF in the diagnosis of non-tuberculous mycobacteria pulmonary disease.
机构信息
Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of the Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Tuberculosis and Infection, Wuhan Jinyintan Hospital, Wuhan, Hubei, China.
出版信息
Int J Infect Dis. 2021 Mar;104:711-717. doi: 10.1016/j.ijid.2020.12.091. Epub 2021 Jan 15.
OBJECTIVE
To evaluate the clinical diagnostic value of positive acid-fast staining combined with negative GeneXpert MTB/RIF in the diagnosis of non-tuberculous mycobacteria pulmonary disease (NTM-PD).
METHODS
A total of 133 inpatients with confirmed NTM-PD were included consecutively between January 1, 2018 and December 31, 2019, at Tongji Hospital and Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, in Wuhan, China. One hundred patients with confirmed pulmonary tuberculosis (PTB) were randomly included as the control group.
RESULTS
The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of positive acid-fast staining combined with a negative GeneXpert MTB/RIF result were 51.13% (95% confidence interval (CI) 42.52-59.73%), 97.00% (95% CI 93.60-100.40%), 95.78% (95% CI 90.98-100.57%), and 59.88% (95% CI 52.25-67.51%), respectively. When subjects were limited to patients with positive acid-fast staining, the sensitivity of a negative GeneXpert MTB/RIF result was 88.31% (95% CI 80.97-95.65%). When acid-fast staining was conducted ≥3 times, the sensitivity of this combination diagnosis method increased to 61.67% (95% CI 49.00-74.33%).
CONCLUSIONS
Positive acid-fast staining combined with a negative GeneXpert MTB/RIF result could be an effective and time-saving method for the diagnosis of NTM-PD.
目的
评估抗酸染色阳性联合GeneXpert MTB/RIF 阴性在非结核分枝杆菌肺病（NTM-PD）诊断中的临床诊断价值。
方法
2018 年 1 月 1 日至 2019 年 12 月 31 日，连续纳入华中科技大学同济医学院附属同济医院和金银潭医院确诊的 133 例 NTM-PD 住院患者。随机纳入 100 例确诊肺结核（PTB）患者作为对照组。
结果
抗酸染色阳性联合 GeneXpert MTB/RIF 阴性结果的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 51.13%（95%置信区间（CI）42.52%-59.73%）、97.00%（95%CI 93.60%-100.40%）、95.78%（95%CI 90.98%-100.57%）和 59.88%（95%CI 52.25%-67.51%）。当仅限于抗酸染色阳性的患者时，GeneXpert MTB/RIF 阴性结果的敏感性为 88.31%（95%CI 80.97%-95.65%）。当抗酸染色进行≥3 次时，该联合诊断方法的敏感性增加至 61.67%（95%CI 49.00%-74.33%）。
结论
抗酸染色阳性联合 GeneXpert MTB/RIF 阴性结果可能是一种有效且省时的 NTM-PD 诊断方法。
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