Xpert MTB/RIF 检测在胸内淋巴结病的结节病和结核鉴别诊断中的应用。

Xpert MTB/RIF assay for the differential diagnosis between sarcoidosis and tuberculosis intrathoracic lymphadenopathy.

机构信息

Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, 507 Zheng Min Road, Shanghai, 200433, China.

Department of Respiratory Disease, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.

出版信息

BMC Infect Dis. 2023 Oct 25;23(1):725. doi: 10.1186/s12879-023-08734-7.

DOI:10.1186/s12879-023-08734-7

PMID:37880573

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10601222/

Abstract

BACKGROUND

The aim of this study was to evaluate the role of Xpert MTB/RIF assay in the detection of Mycobacterium tuberculosis for differentiating tuberculosis intrathoracic lymphadenopathy from sarcoidosis intrathoracic lymphadenopathy.

METHODS

The patients who were suspected to having sarcoidosis or tuberculosis intrathoracic lymphadenopathy at the Shanghai Pulmonary Hospital between October 1, 2020 and June 30, 2021 were retrospectively evaluated in this study. All patients underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and Xpert analysis. Differences in clinical and radiological features were recorded. The diagnostic performances of EBUS-TBNA Xpert, acid-fast bacilli, culture, and peripheral blood QuantiFERON-TB Gold (QFT) for differentiating sarcoidosis from tuberculosis intrathoracic lymphadenopathy were analyzed.

RESULTS

A total of 119 patients were included in this analysis. Of those, 83 patients were finally diagnosed with sarcoidosis (N = 50) and tuberculosis (N = 33) intrathoracic lymphadenopathy. Young individuals were more likely to have tuberculosis versus sarcoidosis intrathoracic lymphadenopathy (P = 0.006). Markers of inflammation, including fever, leukocytes, and serum ferritin levels, were significantly higher in tuberculosis versus sarcoidosis intrathoracic lymphadenopathy (P < 0.01). Bilateral lung involvement and symmetry intrathoracic lymphadenopathy were more common in sarcoidosis intrathoracic lymphadenopathy (P < 0.01). In addition, the longest diameter of intrathoracic lymphadenopathy (in cm) was significantly larger in sarcoidosis intrathoracic lymphadenopathy (P = 0.001). However, the largest diameter of lung lesions was significantly shorter (P = 0.005). The sensitivity and specificity values of Xpert and QFT for differentiating these two diseases were 69.70% and 100%, and 96.43% and 91.84%, respectively.

CONCLUSION

Xpert MTB/RIF is recommended for the diagnosis of tuberculosis intrathoracic lymphadenopathy using EBUS-TBNA samples. A negative QFT suggests the exclusion of the diagnosis of tuberculosis intrathoracic lymphadenopathy.

摘要

背景

本研究旨在评估 Xpert MTB/RIF 检测在鉴别结核性胸内淋巴结病变与结节病性胸内淋巴结病变中的作用。

方法

本研究回顾性评估了 2020 年 10 月 1 日至 2021 年 6 月 30 日期间在上海肺科医院疑似患有结节病或结核性胸内淋巴结病变的患者。所有患者均接受了支气管内超声引导下经支气管针吸活检（EBUS-TBNA）和 Xpert 分析。记录临床和影像学特征的差异。分析 EBUS-TBNA Xpert、抗酸杆菌、培养和外周血 QuantiFERON-TB Gold（QFT）对鉴别结核性胸内淋巴结病变与结节病性胸内淋巴结病变的诊断性能。

结果

本分析共纳入 119 例患者。其中，83 例最终诊断为结核性（N=33）和结节病性（N=50）胸内淋巴结病变。年轻人更有可能患有结核性胸内淋巴结病变而非结节病性胸内淋巴结病变（P=0.006）。炎症标志物，包括发热、白细胞和血清铁蛋白水平，在结核性胸内淋巴结病变中显著高于结节病性胸内淋巴结病变（P<0.01）。双侧肺部受累和对称性胸内淋巴结病变在结节病性胸内淋巴结病变中更为常见（P<0.01）。此外，结节病性胸内淋巴结病变的胸内淋巴结最长直径（cm）显著大于结核性胸内淋巴结病变（P=0.001）。然而，肺部病变的最长直径显著较短（P=0.005）。Xpert 和 QFT 对鉴别这两种疾病的敏感性和特异性分别为 69.70%和 100%，96.43%和 91.84%。