GeneXpert MTB/RIF检测系统在结核病诊断中的应用价值

目的探讨GeneXpert MTB/RIF检测系统(简称GeneXpert MTB/RIF)在结核病诊断中的临床应用价值。方法纳入四川大学华西医院2020年7-9月高度疑似结核病的住院患者(401例),其中临床诊断结核病186例(结核组),非结核病215例(非结核组)。回顾性分析抗酸染色、结核分枝杆菌脱氧核糖核酸(TB-DNA)荧光定量PCR、GeneXpert MTB/RIF、结核感染T细胞γ-干扰素释放试验(TB-IGRA)的检测结果。通过系统性分析各项检测技术的效能指标如灵敏度、特异度等评估GeneXpert MTB/RIF在结核病诊断中的临床价值。结果GeneXpert MTB/RIF在结核病诊断中的灵敏度、特异度、阳性预测值、阴性预测值分别为41.94%、100.00%、100.00%、66.56%。4种检测方法中,GeneXpert MTB/RIF特异度最高,而且其灵敏度明显高于抗酸染色(P<0.05),而与TB-DNA荧光定量PCR相比,虽然其灵敏度较高,但差异无统计学意义(P=0.459)。TB-IGRA检测灵敏度明显优于GeneXpert MTB/RIF,但特异度明显低于其他几种方法。结论GeneXpert MTB/RIF在结核病诊断中具有较高的灵敏度及特异度,有助于临床医生对结核病患者进行早期快速的诊断。

Application value of GeneXpert MTB/RIF detection system in tuberculosis diagnosis

Objective To investigate the clinical application value of GeneXpert MTB/RIF detection system(GeneXpert MTB/RIF)in tuberculosis diagnosis.Methods A total of 401 inpatients with highly suspected tuberculosis in the West China Hospital of Sichuan University from July to September 2020 were included,including 186 cases of clinically diagnosed tuberculosis(tuberculosis group)and 215 cases of non-tuberculosis(non-tuberculosis group).Then the detection results of acid-fast staining,tuberculosis DNA(TB-DNA)fluorescence quantitative polymerase chain reaction(PCR),GeneXpert MTB/RIF and TB-IGRA were retrospectively analyzed.Then the clinical value of GeneXpert MTB/RIF in the diagnosis of tuberculosis was evaluated by analyzing the efficiency indicators of various detection techniques such as sensitivity,specificity.Results The sensitivity,specificity,positive predictive value and negative predictive value of GeneXpert MTB/RIF in the diagnosis of tuberculosis were 41.94%,100.00%,100.00%and 66.56%respectively.GeneXpert MTB/RIF had the best specificity in 4 kinds of detection methods,and its sensitivity was significantly higher than that of acid-fast staining(P<0.05).Compared with TB-DNA PCR,although its sensitivity was higher,but the difference was not statistically significant(P=0.459).The sensitivity of TB-IGRA was significantly superior to GeneXpert MTB/RIF,but its specificity was significantly lower than that of the other methods.Conclusion GeneXpert MTB/RIF has high sensitivity and specificity in the tuberculosis diagnosis,and is conducive to clinical doctor to conduct early rapid diagnosis in the patients with tuberculosis.