超声造影引导下粗针活检联合XpertMTB/RIF检测在周围型肺结核诊断中的应用价值

目的评估超声造影引导下粗针活检联合半巢式全自动实时荧光定量核酸扩增检测技术（XpertMTB/RIF）在周围型肺结核诊断中的应用价值。 方法回顾性分析2016年6月至2018年6月浙江省中西医结合医院结核科疑似周围型肺结核的71例住院患者,所有患者肺部肿块均经超声造影引导下穿刺活检,穿刺组织标本分别进行常规病理检查、XpertMTB/RIF检测及结核分枝杆菌（MTB）培养,以“肺结核诊断和治疗指南”为诊断金标准,比较３种检测方法诊断周围型肺结核的敏感度、特异度、阳性预测值、阴性预测值及准确性。并计算受试者工作特征（ROC）曲线下面积（AUC）,采用t检验比较3种诊断方法的诊断效能差异。以药敏试验为诊断结核标准,评估XpertMTB/RIF方法检验利福平耐药的准确性。 结果71例患者诊断为周围型肺结核40例（结核组）,非周围型肺结核患者31例（非结核组）。非结核组包括肺部恶性肿瘤10例,肺部良性肿瘤1例,间质性肺炎14例,胞内分枝杆菌肺炎3例,真菌性肺炎3例。常规病理、XpertMTB/RIF检测及MTB培养3种检测方法的诊断敏感度分别为80.0%、92.5%、12.5%,特异度分别为90.3%、100%、100%,阳性预测值分别为91.4%、100%、100%,阴性预测值分别为77.8%、91.2%、47.0%,准确性分别为84.5%、95.8%、50.7%。XpertMTB/RIF的诊断敏感度高于常规病理检查及MTB培养,差异具有统计学意义（χ²=33.632、5.976,P均＜0.05）。ROC曲线分析显示常规病理、XpertMTB/RIF检测及MTB培养3种检查方法AUC分别为0.814、0.963、0.563,XpertMTB/RIF的诊断效能优于常规病理检查及MTB培养,AUC比较,差异具有统计学意义（t=7.579、2.303,P均＜0.05）。 结论超声造影引导下粗针活检联合XpertMTB/RIF检测技术能快速、准确地对周围型肺结核进行诊断,相对于常规病理检查、MTB培养具有较高的诊断效能。

Application value of contrast-enhanced ultrasound-guided core needle biopsy and XpertMTB/RIF in diagnosis of peripheral pulmonary tuberculosis

ObjectiveTo evaluate the application value of sonography-guided core needle biopsy and semi-nest fully automatic real-time nucleic acid amplification detection technology (XpertMTB/RIF) in the diagnosis of peripheral tuberculosis. MethodsA retrospective analysis was performed on 71 hospitalized patients with suspected peripheral tuberculosis at the Tuberculosis Department of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital from June 2016 to June 2018. All patients who had lung masses underwent sonography-guided puncture biopsy. The puncture tissue specimens were subjected to routine pathological examination, XpertMTB/RIF assays, and Mycobacterium tuberculosis (MTB) culture. Using the "Guidelines for Diagnosis and Treatment of Tuberculosis" as the diagnostic gold criteria, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the three methods for the diagnosis of peripheral tuberculosis were calculated, and χ² test was used for comparison between groups. The area under the receiver operating characteristic (ROC) curve (AUC) was also calculated to compare the diagnostic efficacy of the three diagnostic methods. The sensitivity of the XpertMTB/RIF method to test rifampicin resistance was assessed using the drug sensitivity test as the diagnostic TB standard. ResultsForty patients were diagnosed with peripheral tuberculosis (tuberculosis) and thrity-one with non-peripheral tuberculosis (non-TB). The non-tuberculous group included ten cases of lung malignancies, one case of benign lung tumor, fourteen cases of interstitial pneumonia, three cases of intracellular mycobacterial pneumonia, and three cases of fungal pneumonia. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the conventional pathology, XpertMTB/RIF, and MTB culture were 80.0%, 92.5%, and 12.5%, 90.3%, 100%, and 100%, 91.4%, 100%, and 100%, 77.8%, 91.2%, and 47.0%, and 84.5%, 95.8%, and 50.7%, respectively. The diagnostic sensitivity of XpertMTB/RIF was higher than that of routine pathological examination or MTB culture (χ²=33.632 and 5.976, respectively; P＜0.05). ROC curve analysis showed that the AUC of onventional pathology, XpertMTB/RIF, and MTB culture was 0.814, 0.963, and 0.563, respectively; XpertMTB/RIF had a significantly better AUC than routine pathology examination and MTB culture (t=7.579 and 2.303, respectively; P＜0.05). ConclusionThe sonography-guided core needle biopsy and XpertMTB/RIF detection technique can make a rapid and accurate diagnosis of peripheral tuberculosis, and has a high diagnostic efficacy compared to routine pathological examination and MTB culture.