4种不同肺结核支气管肺泡灌洗液诊断方法的比较研究

目的 比较不同诊断方法在肺结核患者的支气管肺泡灌洗液（bronchoalveolar lavage fluid，BALF）中的结核分枝杆菌（Mycobacterium tuberculosis，MTB）检出率及利福平耐药率差异，进而评估不同检测技术在肺结核临床诊断中的应用价值。 方法 回顾分析河北省胸科医院就诊的肺结核患者297例，同一时间分别采用BACTEC MGIT960快速培养系统（培养法）、改良抗酸染色法（染色法）、Gene Xpert MTB/RIF系统（Xpert法）及TB-DNA PCR-荧光探针法（PCR法）对同一患者的BALF样本进行MTB及利福平耐药检测，并分析不同诊断方法的结果差异。 结果 培养法、染色法、Xpert法和PCR法的MTB阳性检出率分别为46.465%（138/297）、30.640%（91/297）、55.556%（165/297）和36.364%（108/297），差异有统计学意义（χ2=44.336，P＜0.001）。Xpert法MTB阳性检出率显著高于其他3种方法，培养法显著高于染色法及PCR法，差异有统计学意义（Xpert法相对于其他3种的χ2值分别为4.911、37.592和22.023，P＜0.05；培养法相对于另外2种的χ2值分别为15.698、6.245，P＜0.05），而染色法与PCR法阳性率之间差异无统计学意义（P＞0.05）。培养法、Xpert法和PCR法的利福平耐药检测结果分别为10.145%（14/138）、9.091%（15/165）和10.185%（11/108），差异无统计学意义（P＞0.05）。 结论 4种检测方法在肺结核患者BALF样本中MTB阳性检出率差异较大，BACTEC MGIT960快速培养系统和Gene Xpert MTB/RIF系统能够较好地应用于肺结核患者BALF中MTB及利福平耐药检测，且Xpert法MTB阳性检出率更高、检测时间更快速，而利福平耐药检出率差异无统计学意义（P＜0.05）。

Comparative analysis of four different methods for diagnosis of Mycobacterium tuberculosis in bronchoalveolar lavage fluid of pulmonary tuberculosis

Objective To compare the positive detection rates of Mycobacterium tuberculosis (MTB) and the rate of rifampicin resistance in bronchoalveolar lavage fluid (BALF) of patients with pulmonary tuberculosis by different diagnostic methods, and to evaluate the application value of different detection techniques in the clinical diagnosis of pulmonary tuberculosis (PTB).Methods A retrospective analysis was performed on 297 patients with PTB treated in Hebei Chest Hospital. BACTEC MGIT960 rapid culture system (culture method), modified acid-fast staining method (staining method), Gene Xpert MTB/RIF system (Xpert method) and TB-DNA PCR-fluorescent probe method (PCR method) were used to detect MTB and rifampicin resistance in BALF samples from the same patient, and to analyze the differences in the results of different diagnostic methods.Results The positive detection rates of MTB by culture method, staining method, Xpert method and PCR method were 46.465% (138/297), 30.640% (91/297), 55.556% (165/297) and 36.0364% (108/297), respectively, and the difference was statistically significant (χ2=44.336, P＜0.001). The positive detection rate of MTB by Xpert method was significantly higher than that by the other three methods, and the difference was statistically significant (χ2=4.911, 37.592,P＜0.05). The positive detection rate of MTB by culture method was significantly higher than that by staining and PCR, and the difference was statistically significant (χ2=15.698, 6.245, P＜0.05). However, staining and PCR showed no difference in positive rates of MTB (P＞0.05). The results of rifampicin resistance detection by culture method, Xpert method and PCR method were 10.145% (14/138), 9.091% (15/165) and 10.185% (11/108), respectively, and the difference was not statistically significant (P＞0.05).Conclusion The four detection methods showed great differences in the detection rate of MTB positive in the BALF samples of pulmonary tuberculosis patients. The BACTEC MGIT960 rapid culture system and the Gene Xpert MTB/RIF system can be better applied to the detection of MTB and rifampicin resistance in the BALF of pulmonary tuberculosis patients. In addition, the positive detection rate of MTB by Xpert method is higher and faster, whereas there is no significant difference in the detection rate of rifampicin resistance.