GeneXpertMTB/RIF和Hain技术对痰涂片阴性肺结核诊断价值及利福平耐药性的评估

目的探讨利福平耐药实时荧光定量核酸扩增检测技术(GeneXpertMTB/RIF)、线性探针(Hain)技术对痰涂片阴性肺结核的诊断价值及利福平耐药性的评估价值。方法选择2018年3月至2019年6月上海市浦东新区肺科医院收治的3次痰涂片阴性的疑似肺结核患者254例,对其行痰GeneXpertMTB/RIF、痰Hain技术、痰罗氏培养、绝对浓度法药敏试验。以痰罗氏培养结果为金标准,采用受试者工作特征曲线(ROC)分析GeneXpertMTB/RIF、Hain技术检测痰涂片阴性肺结核的效能;以绝对浓度法药敏试验结果为金标准分析GeneXpertMTB/RIF、Hain技术检测利福平耐药的效能。结果GeneXpertMTB/RIF诊断痰涂片阴性肺结核的敏感度、特异度、准确度分别为82.18%、86.93%、83.52%;Hain技术诊断痰涂片阴性肺结核的敏感度、特异度、准确度分别为67.33%、77.12%、73.23%;GeneXpertMTB/RIF评估利福平耐药性的敏感度、特异度、准确度分别为73.33%、98.84%、95.05%;Hain技术评估利福平耐药性的敏感度、特异度、准确度分别为86.67%、82.56%、83.17%。结论GeneXpertMTB/RIF对痰涂片阴性肺结核的诊断价值及利福平耐药性的评估价值优于Hain技术,GeneXpertMTB/RIF对痰涂片阴性肺结核的快速诊断及治疗具有较好的应用价值。

Value of GeneXpertMTB/RIF and Hain techniques for the diagnosis of sputum smear negative tuberculosis and for the assessment of rifampin resistance

Objective To investigate the application value of Xpert mycobacterium tuberculosis/rifampicin(GeneXpertMTB/RIF)and Hain techniques for the diagnosis of sputum smear negative tuberculosis and for the assessment of rifampin resistance.Methods A total of 254 patients with suspected pulmonary tuberculosis treated in our hospital from March 2018 to June 2019 were enrolled.GeneXpertMTB/RIF,Hain techniques,Roche culture and drug susceptibility testing were performed.Taking Roche culture results as a gold standard,the efficacy of GeneXpertMTB/RIF and Hain techniques in detecting sputum smear-negative pulmonary tuberculosis was analyzed by ROC curve.Based on the results of drug susceptibility testing,the efficacy of GeneXpertMTB/RIF and Hain techniques in detecting rifampicin resistance was analyzed.Results The sensitivity,specificity and accuracy of GeneXpertMTB/RIF in the diagnosis of sputum smear negative pulmonary tuberculosis were 82.18%,86.93%and 83.52%,respectively.The sensitivity,specificity and accuracy of Hain technique in the diagnosis of sputum smear negative pulmonary tuberculosis were 67.33%,77.12%and 73.23%,respectively.The sensitivity,specificity and accuracy of GeneXpertMTB/RIF in evaluating rifampicin resistance were 73.33%,98.84%and 95.05%,respectively.The sensitivity,specificity and accuracy of Hain technique in evaluating rifampicin resistance were 86.67%,82.56%and 83.17%,respectively.Conclusion Compared with Hain technology,GeneXpertMTB/RIF had better clinical value for diagnosis of sputum smear negative tuberculosis and for the assessment of rifampin resistance.This study demonstrates that GeneXpertMTB/RIF technique has a good application value in the rapid diagnosis and treatment of sputum smear negative pulmonary tuberculosis.