荧光定量PCR技术检测肺外结核患者样本临床应用

目的评估赛沛分子检测技术（结核分枝杆菌和利福平耐药基因）（GeneXpert MTB/RIF）检测心包和胸腔积液样本中结核分枝杆菌的有效性。 方法收集2015年1月至2017年6月天门市第一人民人民医院和汉川市人民医院收治的286例结核病疑似患者的临床资料，分别收集158例胸腔积液和128例心包积液样品。每个样品均经过抗酸染色涂片镜检、罗氏培养基结核分枝杆菌培养（LJ培养）和GeneXpert MTB/RIF测定。使用结核分枝杆菌罗氏培养作为金标准，评估GeneXpert MTB/RIF技术检测MTB的有效性。 结果在286例积液样本中，MTB通过LJ培养阳性者51例（17.8%），GeneXpert MTB/RIF测定阳性者43例（15%），抗酸染色镜检阳性者11例（3.8%）。GeneXpert技术灵敏度、特异性、阳性预测值和阴性预测值分别为84.3%、100%、100%和96.7%，抗酸染色方法的灵敏度、特异性、阳性预测值和阴性预测值分别为18.3%、99.1%、81.8%和85.4%。GeneXpert技术检查心包积液中MTB的灵敏度可达90%。GeneXpert MTB/RIF和抗酸染色镜检鉴定两种样本中结核分枝杆菌有效性的差异具有统计学意义（χ² = 233.199、33.715、P均< 0.001）。 结论GeneXpert MTB/RIF技术对于检测胸腔和心包积液中的MTB具有高灵敏度和高特异性。

Clinical application of fluorescent quantitative PCR in detection of patients with extra-pulmonary tuberculosis

ObjectiveTo evaluate the effect of GeneXpert Mycobacterium tuberculosis/Rifampin (GeneXpert MTB/RIF) in detection of Mycobacterium tuberculosis in pericardial and pleural effusion samples. MethodsFrom January 2015 to June 2017, data of 286 suspected cases with tuberculosis were collected from The First people’s Hospital and Hanchuan People’s Hospital. There were 158 cases with pleural effusion and 128 cases with pericardial effusion, respectively. Each sample was examined by acid fast staining, smear microscopy, LJ Culture and GeneXpert MTB/RIF assay, respectively. Taking Mycobacterium LJ culture as the gold standard, the effect of GeneXpert MTB/RIF in detecting MTB was evaluated. ResultsAmong the 286 effusion samples, 5 (17.8%) were MTB positive for LJ cultured, 43 (15%) were MTB positive determined by GeneXpert MTB/RIF, and 11 (3.8%) were MTB positive detected by acid-fast stain microscopy. The sensitivity, specificity, positive predictive value and negative predictive value of GeneXpert technology were 84.3%, 100%, 100% and 84.3%, respectively; while those of the acid fast stain method were 18.3%, 99.1%, 81.8% and 99.1%, respectively. The sensitivity of MTB in pericardial effusion was up to 90% detected by GeneXpert. GeneXpert MTB/RIF and acid-fast stain microscopy showed significant difference in the identification of Mycobacterium tuberculosis in two samples (χ² = 233.199, 33.715; all P < 0.001). ConclusionGeneXpert MTB/RIF technology has high sensitivity and specificity on detecting MTB in pleural effusion and pericardial effusion.