摘要
目的在大样本量支气管肺泡灌洗液(BALF)中分析五种结核检测方法独立和不同联合方式检测结核病的诊断效能,旨在找到一种合适的方案提高临床疑似的肺结核的阳性检出率。方法回顾性分析2016年7月至2021年9月期间在浙江大学医学院附属杭州市胸科医院住院的7718名患者病历资料,所有患者的BALF样本均接受了五项测试:涂片、培养、结核/非结核分枝杆菌核酸检测(TB-DNA)、结核分枝杆菌RNA恒温扩增实时检测技术(SAT-TB)和Xpert MTB/RIF检测(Xpert),以临床诊断为金标准,比较五项独立测试和不同组合方案对肺结核的诊断价值。结果共有7718名患者被纳入分析。涂片、培养、TB-DNA、SAT-TB和Xpert检测肺结核的曲线下面积(AUC)分别为0.58、0.70、0.77、0.73、0.79,Xpert最优。对五种方法进行排列组合并比较诊断效能发现:两项联合中TB-DNA+Xpert联合AUC最佳,三项联合中TB-DNA+Xpert+培养联合AUC最佳,四项联合中TB-DNA+SAT-TB+Xpert+培养联合AUC最佳。对以上最佳组合的AUC进行两两比较发现,两项联合的AUC低于三项和四项(Z分别=9.63、9.90,P均<0.05),三项联合的AUC低于四项和五项(Z分别=4.14、3.65,P均<0.05),五项联合的AUC低于四项(Z=6.97,P<0.05),两项联合与五项的AUC之间比较,差异无统计学意义(Z=1.62,P>0.05)。结论在BALF样本中诊断结核时,Xpert明显优于涂片、培养、TB-DNA、SAT-TB;临床为提高结核阳性检出率进行项目联合时,推荐使用TB-DNA+Xpert联合或TB-DNA+SAT-TB+Xpert+培养联合的方案检测结核。
Objective To analyze the diagnostic values of five tuberculosis detection methods with different combina-tions in large samples of bronchoalveolar lavage fluid(BALF)in detecting tuberculosis,thus to find an appropriate proto-col to improve the positive detection rate of clinically suspected pulmonary tuberculosis.Methods The medical records of inpatients in Hangzhou Chest Hospital Affiliated to Zhejiang University School of Medicine from July 2016 to Septem-ber 2021 were retrospectively analyzed.All patients used the same BALF sample and underwent five tests(smear,culture,TB-DNA,SAT-TB and Xpert).Using clinical diagnosis as the gold standard,the sensitivity,specificity,PPV,NPV and AUC of five tests independently and with different combination regimens were compared.Results A total of 7718 pa-tients were included for analysis.The area under the curve(AUC)of smear,culture,TB-DNA,SAT-TB and Xpert to de-tect pulmonary tuberculosis were 0.58,0.70,0.77,0.73 and 0.79,respectively,and the diagnostic value of Xpert was the best.The five methods were arranged,combined and compared in terms of diagnostic performance,and it showed that the TB-DNA+Xpert combination was the best in the two combinations,the TB-DNA+Xpert+culture combination was the best in the three combinations,and among the four combinations,TB-DNA+SAT-TB+Xpert+culture combination was the best.Comparing the AUC of the above best combina-tions,the AUC of the two combinations was lower than three or four combination(Z=9.63,9.90,P<0.05),and the AUC of the three combination was lower than four or five combination(Z=4.14,3.65,P<0.05),the AUC of the five combination was lower than that of the four combination(Z=6.97,P<0.05),and there was no statistically significant difference in AUC between the two combination and the five combination(Z=1.62,P>0.05).Conclusion When diagnosing tuberculosis in BALF samples,Xpert is significantly better than smear,culture,TB-DNA,and SAT-TB.In order to improve the positive detection rate of tuberculosis,it is recommended to use TB-DNA+Xpert combination or TB-DNA+SAT-TB+Xpert+culture combined protocol to detect tuberculosis.
作者
彭利君
刘立宾
王静
方婷婷
蔡龙
PENG Lijun;LIU Libin;WANG Jing(Clinical Laboratory Center,Affiliated Hangzhou Chest Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)
出处
《全科医学临床与教育》
2022年第9期778-782,F0002,共6页
Clinical Education of General Practice
基金
杭州市医药卫生科技重点项目(ZD20210018)。
关键词
结核
支气管肺泡灌洗液
诊断
分子检测
tuberculosis
bronchoalveolar lavage fluid
diagnosis
molecular detection
