五种方法诊断缩窄性结核性心包炎的对比研究：五种方法诊断缩窄性结核性心包炎。
Head-to-head comparison of the diagnostic value of five tests for constrictive tuberculous pericarditis: Five tests for constrictive TBP.
机构信息
Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
出版信息
Int J Infect Dis. 2022 Jul;120:25-32. doi: 10.1016/j.ijid.2022.04.018. Epub 2022 Apr 14.
BACKGROUND
The diagnosis of constrictive tuberculous pericarditis (TBP) remains challenging. This study aimed to evaluate 5 tests (acid-fast bacilli [AFB] smear, Mycobacterium tuberculosis [MTB] culture, Xpert MTB/RIF assay, CapitalBio Mycobacterium real-time PCR detection assay [CapitalBio assay], and pathology) for constrictive TBP using pericardial tissue.
METHODS
We reviewed the case histories of patients with suspected constrictive TBP. We analyzed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of these assays.
RESULTS
A total of 69 patients were included. The sensitivity, specificity, PPV, NPV, and AUC of AFB smear were 7.3%, 100.0%, 100.0%, 21.5%, and 0.54, respectively; those of culture were 23.6%, 100.0%, 100.0%, 25.0%, and 0.62, respectively; those of Xpert MTB/RIF were 52.7%, 100.0%, 100.0%, 35.0%, and 0.76, respectively; those of CapitalBio assay were 50.9%, 100.0%, 100.0%, 34.2%, and 0.75, respectively; and those of pathology were 92.7%, 92.9%, 98.1%, 76.5%, and 0.93, respectively.
CONCLUSIONS
The validity of AFB smear and MTB culture remains low. Nucleic acid amplification tests can provide diagnostic efficacy for TBP but only moderately. The CapitalBio assay and Xpert MTB/RIF were considered similar for diagnosing TBP. Pathology showed the best diagnostic accuracy among the 5 tests.
背景
缩窄性结核性心包炎（TBP）的诊断仍然具有挑战性。本研究旨在评估 5 种测试（抗酸杆菌 [AFB] 涂片、分枝杆菌 [MTB] 培养、Xpert MTB/RIF 检测、CapitalBio 分枝杆菌实时 PCR 检测 [CapitalBio 检测] 和病理学）使用心包组织对缩窄性 TBP 的诊断价值。
方法
我们回顾了疑似缩窄性 TBP 患者的病史。我们分析了这些检测的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）。
结果
共纳入 69 例患者。AFB 涂片的敏感性、特异性、PPV、NPV 和 AUC 分别为 7.3%、100.0%、100.0%、21.5%和 0.54；培养的敏感性、特异性、PPV、NPV 和 AUC 分别为 23.6%、100.0%、100.0%、25.0%和 0.62；Xpert MTB/RIF 的敏感性、特异性、PPV、NPV 和 AUC 分别为 52.7%、100.0%、100.0%、35.0%和 0.76；CapitalBio 检测的敏感性、特异性、PPV、NPV 和 AUC 分别为 50.9%、100.0%、100.0%、34.2%和 0.75；病理学的敏感性、特异性、PPV、NPV 和 AUC 分别为 92.7%、92.9%、98.1%、76.5%和 0.93。
结论
AFB 涂片和 MTB 培养的有效性仍然较低。核酸扩增检测可为 TBP 提供诊断效能，但仅为中等程度。CapitalBio 检测和 Xpert MTB/RIF 被认为对 TBP 的诊断具有相似的价值。病理学在 5 种检测中显示出最佳的诊断准确性。
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