5种病原学检测方法在肺结核病诊断中的应用评价

目的 评价涂片法(AFS)、罗氏培养法(L-J)、环介导等温扩增法(LAMP)、多色半巢式荧光定量PCR(Xpert MTB/RIF)、线性探针技术(LPA)对肺结核病的诊断价值。方法 选取2016年1月— 2018年3月陕西省结核病防治研究所和汉中市第二人民医院就诊的258例肺结核可疑症状者作为研究对象,同时应用AFS、L-J、LAMP、Xpert MTB/RIF、LPA对所有研究对象的同一份痰样本进行检测,以临床诊断为标准,分组计算5种病原学检测方法的阳性率;以培养和鉴定为金标准,计算4种方法的敏感度和特异度,并结合受试者工作特征 (ROC)曲线进行分析比较。结果 在肺结核病组中LAMP(73.30%)、Xpert MTB/RIF(77.27%)、LPA(70.45%)的阳性率均显著高于AFS(46.02%)和L-J(58.52%),差异均有统计学意义;以培养和鉴定为金标准,AFS、LAMP、Xpert MTB/RIF、LPA的敏感度分别为68.93%、93.20%、97.09%、92.23%;特异度分别为93.55%、74.84%、75.48%、83.23%;ROC曲线下的面积分别为0.812、0.840、0.863、0.877,P均< 0.05。结论 5种病原学检测方法对肺结核病的诊断均具有较好的辅助作用;与AFS和L-J相比,LAMP、Xpert MTB/RIF、LPA具有较高的阳性检出率,有助于传染源的早期发现。

Evaluation of five etiological detection methods in the diagnosis of pulmonary tuberculosis

To evaluate diagnostic value of acid-fast bacilli smear(AFS), Lowenstein-Jensen culture(L-J), loop-mediated isothermal amplification(LAMP), Xpert MTB/RIF and line probe assay(LPA) in the diagnosis of pulmonary tuberculosis, a total of 258 pulmonary tuberculosis suspects were continuously recruited in Shaanxi Provincial Institute for Tuberculosis Control and Prevention and The second people's Hospital of Hanzhong from January 2016 to March 2018, AFS, L-J, LAMP, Xpert MTB/RIF and LPA were used to detect the same sputum from all subjects, the positive rate of 5 etiological detection methods was calculated according to the clinical diagnostic. Using L-J and p-nitrobenzoic acid(PNB) method result as the gold standard, the sensitivity and specificity of detected results were analyzed by the receiver operation characteristic(ROC) curve. Results showed that the positive rate of LAMP(73.30%), Xpert MTB/RIF(77.27%) and LPA(70.45%) were significantly higher than that of AFS(46.02%) and L-J (58.52%) in the pulmonary tuberculosis group, the difference being significant. Using L-J and PNB method result as the gold standard, the sensitivities of AFS, LAMP, Xpert MTB/RIF and LPA were 68.93%, 93.20%, 97.09% and 92.23%, respectively, the specificitives were 93.55%, 74.84%, 75.48% and 83.23%, respectively, the area under ROC curve were 0.812, 0.840, 0.863 and 0.877. In conclusion, the 5 etiological detection methods show good results for auxiliary diagnosis of pulmonary tuberculosis. Compared with AFS and L-J, the LAMP, Xpert MTB/RIF and LPA have higher postive detection rate for early detection of infectious source.