结核分枝杆菌/利福平耐药基因联合结核感染T细胞斑点检测在耐药结核性胸膜炎中的应用价值

目的 探讨结核分枝杆菌/利福平耐药基因检测（Xpert MTB/RIF）联合结核感染T细胞斑点检测（T-SPOT.TB）对耐药性结核性胸膜炎诊断及治疗的价值。方法 选取2014年1月至2019年12月河北省胸科医院收治的62例结核性胸膜炎患者为结核性胸膜炎组,选择同期来河北省胸科医院院救治的非结核性胸膜炎患者60例为对照组。分析比较两组一般资料,留取两组胸腔积液样本进行Xpert MTB/RIF、T-SPOT.TB、结核菌培养+药敏等检测,胸腔积液结核菌培养阳性作为诊断结核性胸膜炎的金标准。结果 Xpert MTB/RIF、T-SPOT.TB、两种方法并联检测结核性胸膜炎的灵敏度分别为79.0%、88.7%、96.8%,特异度分别为90.0%、81.7%、95.0%,均明显高于ADA及抗酸染色诊断的敏感度及特异度,差异有统计学意义（P均<0.05）。以结核菌药敏检测为金标准,Xpert MTB/RIF检测利福平耐药的敏感度为89.47%,两者一致性较好（Kappa=0.900）。结论 Xpert MTB/RIF联合T-SPOT.TB检测提高了结核性胸膜炎诊断的敏感度和特异度,降低误诊率,同时Xpert MTB/RIF可快速检测出胸水中耐利福平的结核分枝杆菌感染,有利于耐药结核性胸膜炎的早期诊断及治疗。

Xpert MTB/RIF combined with T-SPOT.TB in the diagnostic value of drug-resistant tuberculous pleurisy

Objective To investigate the diagnostic value of Xpert MTB/RIF combined with T-SPOT.TB in the drug-resistant tuberculous pleurisy.MethodsSixty-two patients with drug-resistant tuberculous pleurisy were selected astuberculous pleurisy group, and 60 patients with other diseases and pleural effusion admitted to Hebei Province Chest Hospitalfrom January 2014 to December 2019 were selected as the control. General clinical data were collected and analyzed, twogroups of pleural effusion samples were collected for detection of Xpert MTB/RIF, T-SPOT.TB and tubercle bacillus cultureand drug sensitivity, etc, tubercle bacillus culture of pleural effusion was used as the gold standard for the diagnosis oftuberculous pleurisy.ResultsThe sensitivity of Xpert MTB/RIF, T-SPOT.TB and two parallel methods was 79.0%, 88.7%,96.8% respectively, the specificity was 90.0%, 81.7%, 95.0% respectively,the diagnostic sensitivity, specificity weresignificantly higher than those of ADA and acid fast staining(all P<0.05). Taking the tuberclebacillus drug sensitivity as thegold standard, the sensitivity of Xpert MTB/RIF test for rifampicin resistance was 89.47%, and the consistency between the twomethods was good(Kappa=0.900).ConclusionXpert MTB/RIF combined with T-SPOT.TB in the diagnosis of tuberculouspleurisy can improve the sensitivity and specificity, reduce the misdiagnosis rate, at the same time, Xpert MTB/RIF can quicklydetect rifampicin resistance of Mycobacterium tuberculosis in pleural effusion, be conducive to the early diagnosis and treatmentof drug-resistant tuberculous pleurisy.