三种检测方法在结核病中的诊断价值比较

目的比较3种检测方法在不同类型结核病中的诊断价值。方法选取2020年1-12月于该院住院的患者140例为研究对象,其中结核病组111例(肺结核组103例和肺外结核组8例),非结核病组29例。同时采用外周全血γ-干扰素释放试验(IGRA)、结核分枝杆菌培养、实时荧光定量核酸扩增检测(Xpert MTB/RIF)3种方法检测各组患者的标本,比较3种检测方法的诊断价值。结果IGRA、结核分枝杆菌培养和Xpert MTB/RIF在结核病组患者中的阳性率分别为87.39%、37.84%和64.86%,与非结核病组比较(27.59%、0.00%、0.00%),差异有统计学意义(P<0.05)。肺结核组与肺外结核组3种检测方法的阳性率比较差异无统计学意义(P>0.05)。IGRA在菌阳患者和菌阴患者中的阳性率比较,差异无统计学意义(P>0.05)。IGRA和结核分枝杆菌培养联合检测的灵敏度、特异度、曲线下面积(AUC)、阳性预测值和阴性预测值分别为90.99%、72.41%、0.869、92.7%、67.7%。IGRA和Xpert MTB/RIF联合检测的灵敏度、特异度、AUC、阳性预测值和阴性预测值分别为96.40%、72.41%、0.934、93.0%、84.0%。结论IGRA诊断结核病的阳性率最高;IGRA和Xpert MTB/RIF联合检测的灵敏度、AUC、阳性预测值和阴性预测值均优于IGRA和结核分枝杆菌培养联合检测,可为临床医生诊断结核病提供参考。

Comparison of the diagnostic value of three detection methods in tuberculosis

Objective To compare the comparison of the diagnostic value of three detection methods in tuberculosis.Methods A total of 140 patients who were hospitalized in this hospital from January to December 2020 were selected as the reseach objects,including 111 patients in the tuberculosis group(103 in the pulmonary tuberculosis group and 8 in the extrapulmonary tuberculosis group)and 29 patients in the non-tuberculosis group.The blood samples of patients in each group were detected by three methods,including peripheral whole bloodγ-interferon release assay(IGRA),Mycobacterium tuberculosis culture,and real-time fluorescence quantitative nucleic acid amplification assay(Xpert MTB/RIF).The diagnostic value of the three detection methods was compared.Results The positive rates of IGRA,Mycobacterium tuberculosis culture and Xpert MTB/RIF in tuberculosis group were 87.39%,37.84%and 64.86%,respectively,compared with those in non-tuberculosis group(27.59%,0.00%,0.00%),the differences were statistically significant(P<0.05).There was no significant difference in the positive rates of the three detection methods between the pulmonary tuberculosis group and the extrapulmonary tuberculosis group(P>0.05).There was no significant difference in the positive rate of IGRA between bacteria-positive patients and bacteria-negative patients(P>0.05).The sensitivity,specificity,area under the curve(AUC),positive predictive value and negative predictive value of IGRA and Mycobacterium tuberculosis culture combined detection were 90.99%,72.41%,0.869,92.7%and 67.7%,respectively.The sensitivity,specificity,AUC,positive predictive value and negative predictive value of IGRA and Xpert MTB/RIF combined detection were 96.40%,72.41%,0.934,93.0%and 84.0%,respectively.Conclusion The positive rate of IGRA in the diagnosis of tuberculosis is the highest;the sensitivity,AUC,positive predictive value and negative predictive value of IGRA and Xpert MTB/RIF combined detection are better than those of IGRA and Mycobacterium tuberculosis culture combined detection,which can provide reference for clinicians to diagnose tuberculosis.