支气管肺泡灌洗液行Xpert MTB/RIF检测对涂阴肺结核的诊断分析

目的:探究支气管肺泡灌洗液行Xpert MTB/RIF检测对涂阴肺结核的诊断价值。方法:选择本院2017年3月-2019年3月接收96例涂阴肺结核患者作为研究样本,对其给予支气管镜检查进行刷检、收集支气管肺泡灌洗,同时给予涂片镜检找抗酸杆菌、结核分枝杆菌培养及利福平耐药实时荧光定量核酸扩增技术(Xpert MTB/RIF)检测,统一诊断。分别以支气管肺泡灌洗的罗氏培养结果及临床诊断标准作为肺结核诊断的阳性标准,计算行Xpert MTB/RIF检测的诊断灵敏度、特异性以及阴性率等。结果:96例涂阴肺结核患者中,临床诊断60例肺结核患者,36例非肺结核患者。肺结核的阳性标准以支气管肺泡灌洗培养阳性结果为准,肺泡灌洗行Xpert MTB/RIF检测对诊断涂阴肺结核的灵敏度、特异性分别为100.00%(28/28)、97.22%(35/36)。以药物敏感试验(Drug Sensitivity Test,DST)结果为金标准,肺泡灌洗Xpert MTB/RIF检测利福平耐药的敏感度、特异性分别为60.00%(3/5)、91.30%(21/23)。结论:在涂阴肺结核中肺泡灌洗行Xpert MTB/RIF检测特异性与灵敏度较高,有利于快速提供诊断参考。

Analysis of the Xpert MTB/RIF detection of bronchoalveolar lavage fluid on diagnosis of smear-negative pulmonary tuberculosis

Objective:To explore the diagnostic value of Xpert MTB/RIF detection of bronchoalveolar lavage fluid on smearnegative pulmonary tuberculosis.Methods:A total of 96 patients with smear-negative pulmonary tuberculosis were selected from our hospital from March 2017 to March 2019.They were given bronchoscopy for brushing,bronchoalveolar lavage,and smear microscopy for acid resistance.Bacterium,Mycobacterium tuberculosis culture and Xpert MTB/RIF detection,unified diagnosis.The Roche culture results and clinical diagnostic criteria of bronchoalveolar lavage were used as the positive criteria for the diagnosis of tuberculosis,and the diagnostic sensitivity,specificity and negative rate of Xpert MTB/RIF were calculated.Results:96 patients with smear-negative pulmonary tuberculosis,60 were diagnosed with tuberculosis and 36 were non-tuberculous.The positive criteria of tuberculosis are based on the positive results of bronchoalveolar lavage culture.The sensitivity and specificity of Xpert MTB/RIF test for the diagnosis of smear-negative pulmonary tuberculosis were 100.00%(28/28)and 97.22%(35/36).Using the results of the DST as the gold standard,the sensitivity and specificity of Xpert MTB/RIF for detecting rifampicin resistance were 60.00%(3/5)and 91.30%(21/23).Conclusion:Xpert MTB/RIF detection with alveolar lavage on smear-negative pulmonary tuberculosis has higher specificity and sensitivity,which is conducive to providing rapid reference for diagnosis.