Sun Yue, Zhang Qing, Zhang Qin, Liu Chang, Zhang Hong, Fu Yinghui, Liu Yongyu, Hou Gang
Institute of Respiratory Diseases, The First Hospital of China Medical University, Shenyang, China.
Department of Endoscopy, Shenyang Chest Hospital, Shenyang, China.
Front Med (Lausanne). 2021 Aug 18;8:682107. doi: 10.3389/fmed.2021.682107. eCollection 2021.
The Xpert /rifampin (MTB/RIF) assay has shown good diagnostic efficacy in brushing and biopsy tissue samples from patients with tracheobronchial tuberculosis (TBTB). However, its diagnostic value in bronchoalveolar lavage fluid (BALF) is still unclear. Therefore, the present retrospective study aimed to evaluate the diagnostic value of the Xpert MTB/RIF assay in BALF. The clinical data of 266 patients with suspected TBTB from January 2018 to October 2020 were pooled with complete details of bronchial brush and bronchoalveolar lavage samples. Smears of the bronchial brushings were stained with Auramine O stain to detect acid-fast bacilli (AFB), and BALF samples were used for culturing MTB with the BACTEC MGIT 960 system and the Xpert MTB/RIF assay. The diagnostic performance of these methods was assessed and compared. A total of 266 patients suspected to have TBTB were enrolled in the final analysis. Of these patients, 179 patients were confirmed to have TBTB and 87 patients were non-TBTB. The sensitivity of the Xpert MTB/RIF assay in BALF (87.2%) was significantly higher than that of the brush smear for AFB (35.2%, < 0.001). No significant difference was observed between the sensitivities of the Xpert MTB/RIF assay in BALF and MTB culture in BALF (87.2 vs. 84.9%, = 0.542). The specificities of the Xpert MTB/RIF assay in BALF, MTB culture in BALF, and the bronchial brush smear were 97.7, 97.7, and 98.9%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of the Xpert MTB/RIF assay in BALF, MTB culture in BALF, and the bronchial brush smear were 98.7 and 78.7%, 98.7 and 75.9%, and 98.4 and 42.6%, respectively. Among the MTB culture-positive patients with TBTB detected by the Xpert assay, 27.0% (20/74) were identified to be resistant to RIF. The Xpert MTB/RIF assay in BALF enables a rapid and accurate diagnosis of TBTB and identification of RIF resistance, which is crucial for timely and proper treatment. Moreover, in patients with TBTB, BALF could be used as an alternative to bronchial brushing and biopsy tissues for the Xpert MTB/RIF assay.
Xpert/利福平（MTB/RIF）检测在气管支气管结核（TBTB）患者的刷检和活检组织样本中显示出良好的诊断效能。然而，其在支气管肺泡灌洗液（BALF）中的诊断价值仍不明确。因此，本回顾性研究旨在评估Xpert MTB/RIF检测在BALF中的诊断价值。收集了2018年1月至2020年10月期间266例疑似TBTB患者的临床资料，包括支气管刷检和支气管肺泡灌洗样本的完整详细信息。支气管刷检涂片用金胺O染色以检测抗酸杆菌（AFB），BALF样本用于采用BACTEC MGIT 960系统培养结核分枝杆菌（MTB）以及进行Xpert MTB/RIF检测。评估并比较了这些方法的诊断性能。共有266例疑似患有TBTB的患者纳入最终分析。在这些患者中，179例被确诊为TBTB，87例为非TBTB。Xpert MTB/RIF检测在BALF中的敏感性（87.2%）显著高于AFB刷检涂片的敏感性（35.2%，P<0.001）。Xpert MTB/RIF检测在BALF中的敏感性与BALF中MTB培养的敏感性之间未观察到显著差异（87.2%对84.9%，P=0.542）。Xpert MTB/RIF检测在BALF中的特异性、BALF中MTB培养的特异性以及支气管刷检涂片的特异性分别为97.7%、97.7%和98.9%。Xpert MTB/RIF检测在BALF中的阳性预测值（PPV）和阴性预测值（NPV）、BALF中MTB培养的PPV和NPV以及支气管刷检涂片的PPV和NPV分别为98.7%和78.7%、98.7%和75.9%、98.4%和42.6%。在通过Xpert检测发现的MTB培养阳性的TBTB患者中，27.0%（20/74）被鉴定为对利福平耐药。BALF中的Xpert MTB/RIF检测能够快速准确地诊断TBTB并鉴定利福平耐药情况，这对于及时恰当的治疗至关重要。此外，对于TBTB患者，BALF可作为支气管刷检和活检组织的替代样本用于Xpert MTB/RIF检测。
