中国防痨杂志2024，Vol.46Issue(9)：1037-1041,5.DOI:10.19982/j.issn.1000-6621.20240062
综合医院GeneXpert MTB/RIF检测支气管肺泡灌洗液极低结核分枝杆菌诊断肺结核的准确性
Diagnostic accuracy of GeneXpert MTB/RIF in detecting pulmonary tuberculosis with extremely low loads of MTB in bronchoalveolar lavage fluid in general hospitals
摘要
Abstract
Objective:To evaluate the accuracy of diagnosing pulmonary tuberculosis(PTB)with extremely low loads of Mycobacterium tuberculosis(MTB)(Ct value＞28)in bronchoalveolar lavage fluid by GeneXpert MTB/RIF(BALF-Xpert)in Wuhan general hospitals.Methods:A prospective study was conducted on PTB patients admitted to the Department of Respiratory and Critical Care Medicine of Wuhan Pulmonary Hospital from January 1,2019 to December 30,2022,who were referred from 12 general hospitals with extremely low loads of MTB detected by BALF-Xpert.The results of retesting BALF-Xpert,acid-fast bacilli smear microscopy,mycobacterial culture,TB-RNA,and TB-DNA were analyzed.All patients were clinically diagnosed by 3 or more associate professors and followed up for at least 1 year to evaluate the accuracy of BALF-Xpert in detecting MTB with extremely low loads in general hospitals.Results:A total of 67 patients were included.After retesting with BALF-Xpert,38.81％(26/67)were detected as MTB positive,including 20 cases(76.92％)with extremely low loads,5 cases(19.23％)with low loads,1 case(3.85％)with medium loads,and 0 case with high loads of MTB.The positive rate of BALF-Xpert was higher than that of smear microscopy(4.48％(3/67))and TB-RNA(17.91％(12/67)),with statistically significant difference(x2=23.280,P=0.001;x2=7.200,P=0.007).There was no significant difference between BALF-Xpert and culture(29.85％(20/67))and TB-DNA(25.37％(17/67))(x2=1.192,P=0.275;x2=2.774,P=0.096).The total positive rate of combining 5 diagnostic methods was 40.30％(27/67).Forty-three patients were finally diagnosed with tuberculosis and 24 patients were diagnosed as non-tuberculosis disease,with a misdiagnosis rate of 35.82％.Conclusion:BALF-Xpert has a high false positive rate for detection of PTB cases with extremely low loads MTB.A comprehensive diagnosis should be made based on the patient's clinical manifestations,imaging findings,and immunological results for MTB infection and re-examination is recommended,if necessary.关键词
医院,综合/核酸扩增技术/结核,肺/诊断/误诊Key words
Hospital,general/Nucleic acid amplification techniques/Tuberculosis,pulmonary/Diagnosis/Misdiagnosis分类
医药卫生引用本文复制引用
梅春林,杨澄清,杜荣辉,曹探赜,冯伟,陈淑芳,刘修平,欧佳莉..综合医院GeneXpert MTB/RIF检测支气管肺泡灌洗液极低结核分枝杆菌诊断肺结核的准确性[J].中国防痨杂志,2024,46(9):1037-1041,5.基金项目
Health Commission of Hubei Province Scientific Research Project(WJ2019H320) （WJ2019H320）
Wuhan Medical Young Talent Training Project(201987) （201987）
The Funds of Wuhan Pulmonary Hospital(YNZZ202209)湖北省卫生健康科研项目(WJ2019H320) （YNZZ202209）
武汉医学中青年骨干人才培养工程(201987) （201987）
武汉市肺科医院院内科研项目(YNZZ202209) （YNZZ202209）
