摘要
目的探讨Xpert MTB/RIF检测方法在经皮肺穿刺活检的肺组织诊断肺结核的价值。方法选取2017年4月至2019年11月湖北省襄阳市第一人民医院及昆明医科大学第二附属医院呼吸与危重症医学科入住的临床高度疑似肺结核患者150例,所有患者均进行痰荧光涂片及痰结核分枝杆菌培养,根据CT提示病灶在肺内的分布分为外周组和中央组,外周组采用经皮肺穿刺活检获取肺组织,中央组采用经支气管镜获取支气管肺泡灌洗液,两种方法获取的样本均进行Xpert MTB/RIF检测,比较不同部位不同方法在肺结核中的诊断价值。结果共纳入146例患者,肺穿刺组72例(男38例,女34例),支气管镜检查组74例(男44例,女30例)。以痰培养结果为诊断标准时,肺组织Xpert MTB的灵敏度、特异度和准确性分别为:87.04%、61.11%和80.56%;支气管肺泡灌洗液Xpert MTB的灵敏度、特异度和准确性分别为:85.96%、47.59%和77.03%。肺组织Xpert MTB与痰培养相比,支气管肺泡灌洗液Xpert MTB与痰培养相比,阳性率差异无统计学意义(P> 0.05)。结论 Xpert MTB/RIF检测肺组织及肺泡灌洗液的灵敏度及准确性均较高,对于肺外周病灶采用经皮肺穿刺活检获取肺组织具有优势,对于肺中央病灶进行支气管镜检查获取支气管肺泡灌洗液具有优势,RIF检测对肺结核的治疗提供帮助。
Objective The aim of this study is to investigate the diagnostic value of Xpert mycobacterium tuberculosis/rifampin Assay(Xpert MTB/RIF) combined with CT-guided percutaneous lung biopsy in pulmonary tuberculosis. Methods 150 clinically suspected tuberculosis patients were recruited from the Fisrt People’s Hospital of Xiangyang and The Second Affiliated Hospital of Kunming Medical University from April 2017 to November 2019.Sputum samples from all patients were collected. Based on computed tomography(CT) distribution of the lesions in the lungs, these patients were divided into the peripheral group and the central group. The lung samples were obtained by CT-guided percutaneous lung biopsy, and bronchoalveolar lavage fluid(BALF) were obtained by video bronchoscope. The sensitivity, specificity and accuracy of these different detection assays were analyzed.Results A total of 146 patients were included. 72 patients were assigned into in the peripheral group(38 males and34 females) and 74 patients were assigned into in the central group(44 males and 30 females). Liquid culture results in sputum were considered as the standard diagnosis. The sensitivity,specificity and accuracy of percutaneous lung biopsy Xpert MTB were: 87.04%, 61.11% and 80.56%, respectively. The sensitivity, specificity and accuracy of BALF Xpert MTB by bronchoscopy were 85.96%, 47.59% and 77.03%, respectively. There was no significance between liquid culture results and Xpert MTB/RIF in percutaneous lung biopsy or BALF(P > 0.05).Conclusion Xpert MTB/RIF has high sensitivity and accuracy in detecting lung tissue and alveolar lavage fluid. It is advantageous to obtain lung tissue by percutaneous lung biopsy for peripheral lung lesions and bronchoalveolar lavage fluid by bronchoscopy for central lung lesions. The RIF test helps in the treatment of tuberculosis.
作者
蔡和伦
李平
董燕
陈俊文
董昭兴
CAI He-lun;LI Ping;DONG Yan;CHEN Jun-wen;DONG Zhao-xing(Dept.of Respiratory and Critical Care Medicine,Affiliated Xiangyang Hospital of Hubei University of Medicine,Xiangyang Hubei 441000;Dept.of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)
出处
《昆明医科大学学报》
CAS
2020年第8期94-99,共6页
Journal of Kunming Medical University
基金
湖北省自然科学基金资助项目(2016CFB410)。
关键词
经皮肺穿刺活检
Xpert
MTB/RIF
结核分枝杆菌
支气管镜
肺泡灌洗液
CT-guided percutaneous transthoracic needle biopsy
Xpert MTB/RIF
Mycobacterium tuberculosis
Bronchoscopy
Alveolar lavage fluid
