GeneXpert 联合基因芯片在涂阴 MTB 诊断中的价值及患者血清sTREM-1、 PCT 水平及意义

目的 探讨利福平耐药实时荧光定量核酸扩增技术 ( rifampicin resistant real-time fluorescent quantitative nucleic acid amplification, GeneXpert MTB/ RIF) 联合基因芯片技术在涂阴结核分支杆菌 (Mycobacterium tuberculosis, MTB) 诊断中的价值及血清可溶性髓系细胞触发受体-1 ( serum soluble triggering receptor-1,sTREM-1)、 降钙素原 (procalcitonin, PCT) 水平的意义。 方法 选取 2019 年 1 月至 2021 年 1 月在聊城市人民医院就诊的疑似涂阴肺结核患者130 例, 采集肺泡灌洗液, 给予 GeneXpert MTB/ RIF、 基因芯片及药敏试验检查, 同时检查肺结核患者血清 sTREM-1、 PCT 水平。 以肺泡灌洗液结核菌培养及药敏试验为金标准评价 GeneXpert MTB/ RIF 联合基因芯片检测对涂阴肺结核的诊断价值。 采用 ROC 评价血清 sTREM-1、 PCT对涂阴肺结核的诊断价值。 结果 以肺泡灌洗液结核菌培养诊断出非涂阴肺结核患者 58 例, 涂阴肺结核患者 72 例。 GeneXpert MTB/ RIF 联合基因芯片诊断肺结核的灵敏性为 68. 06 % , 高于基因芯片单独诊断 (P<0. 05), GeneXpert MTB/ RIF 联合基因芯片诊断肺结核的特异性、 准确性、 阳性预测值和阴性预测值分别为91. 38 % 、 78. 46 % 、 90. 74 % 和 69. 74 % , 与 GeneXpert MTB/ RIF 诊断、 基因芯片单独诊断比较差异无统计学意义 (P> 0. 05); GeneXpert MTB/ RIF 联合基因芯片诊断 MDR-TB 的灵敏性、 特异性、 准确性、 阳性预测值和阴性预测值分别为 94. 12 % 、 85. 45 % 、 87. 50 % 、 66. 67 % 和 97. 92 % , 与 GeneXpert MTB/ RIF诊断基因芯片单独诊断比较差异无统计学意义 (P> 0. 05); 重症肺结核患者血清 sTREM-1、 PCT 分别为(18. 04 ± 2. 07) ng / ml 和 (2. 09 ± 0. 19) ng / ml, 明显高于轻症肺结核患者 ( P< 0. 05); 血清 sTREM-1、PCT 预测重症肺结核的 ROC 曲线下面积分别为 0. 811 和 0. 844, 截断值分别为 16. 32 ng / ml 和 2. 00 ng / ml,灵敏性分别为 89. 30 % 和 82. 00 % , 特异性分别为 61. 40 % 和 79. 60 % 。 结论 GeneXpert 联合基因芯片技术可提高涂阴 MTB 诊断灵敏性, 且两种手段对 MDR-TB 均有较好的诊断价值。 重症肺结核患者 sTREM-1、PCT 水平明显高于轻症肺结核, 血清 sTREM-1、 PCT 对重症肺结核诊断灵敏性、 特异性较高, 可作为早期诊断的手段加以应用。

Value of GeneXpert Combined with Gene Chip Technology in the Diagnosis of Smear-negative MTB and the Clinical Significance of SerumsTREM-1 and PCT Levels in Pulmonary Tuberculosis

Objective To investigate the value of rifampicin resistant real-time fluorescentquantitative nucleic acid amplification technology (GeneXpert MTB / RIF) combined with the genechip technology in the diagnosis of smear-negative Mycobacterium tuberculosis (MTB) and the clinical significance of serum soluble triggering receptor-1 (sTREM-1) and procalcitonin (PCT) levelsin pulmonary tuberculosis. Methods A total of 130 cases of suspected smear-negative pulmonarytuberculosis patients in Liaocheng People’s Hospital from January 2019 to January 2021 were selected. Alveolar lavage fluid were collected, GeneXpert MTB / RIF were performed, gene chip methodwere applied, and the serum levels of sTREM-1 and PCT were detected. The alveolar lavage fluidtuberculosis culture method and the drug sensitivity test were used as the gold standard to evaluatethe diagnostic value of GeneXpert MTB / RIF combined with gene chip technology for the smear-negative pulmonary tuberculosis. ROC analysis was used to evaluate the diagnostic value of serumsTREM-1 and PCT in smear-negative pulmonary tuberculosis. Results A total of 58 patients withnon-smear-negative pulmonary tuberculosis and 72 patients with smear-negative pulmonary tuberculosis were diagnosed by using the alveolar lavage fluid tuberculosis culture method. The sensitivity ofGeneXpert MTB / RIF combined with gene chip technology for the diagnosis of pulmonary tuberculosis was 68. 06 % , which was higher than that of gene chip method alone (P< 0. 05). The specificity, accuracy, positive predictive value and negative predictive value of GeneXpert MTB / RIF combined with gene chip method for the diagnosis of pulmonary tuberculosis were 91. 38 % , 78. 46 % ,90. 74 % and 69. 74 % , respectively, despite that the differences were not statistically significantwhen compared with the GeneXpert MTB / RIF or gene chip method alone (P> 0. 05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of GeneXpertMTB / RIF combined with gene chip method for the diagnosis of MDR-TB were 94. 12 % , 85. 45% , 87. 50 % , 66. 67 % and 97. 92 % , respectively, compared with GeneXpert MTB / RIF andgene chip method alone, the differences were not statistically significant (P> 0. 05). The levels ofserum sTREM-1 and PCT in patients with severe pulmonary tuberculosis were (18. 04 ± 2. 07)ng / mL and (2. 09 ± 0. 19) ng / mL respectively, which were significantly higher than those in patients with mild pulmonary tuberculosis ( P < 0. 05 ). The areas under the ROC curve of serumsTREM-1 and PCT for the prediction of severe pulmonary tuberculosis were 0. 811 and 0. 844. Thecut-off values were 16. 32 ng / mL and 2. 00 ng / mL, the sensitivities were 89. 30 % and 82. 00 % ,the specificities were 61. 40 % and 79. 60 % , respectively. Conclusion The GeneXpert combinedwith gene chip technology can improve the diagnostic sensitivity of smear-negative MTB, and bothmethods have good diagnostic values for MDR-TB. The levels of sTREM-1 and PCT in patients with severe pulmonary tuberculosis were significantly higher than those in patients with mild pulmonary tuberculosis. Serum sTREM-1 and PCT have high sensitivities and specificitise in the diagnosis of severepulmonary tuberculosis, which can be applied for the early diagnosis of pulmonary tuberculosis.