支气管肺泡灌洗液Xpert MTB/RIF检验在痰涂阴肺结核发现中的价值

摘要

目的 比较Xpert MTB/RIF检验与痰涂片及培养法检出率,探讨其对痰涂阴肺结核发现的价值.方法 选取2014年7月~2015年7月天津海河医院收治的拟诊肺结核(且查痰结核菌涂片3次阴性)的69例患者进行纤维气管镜检查.以最终诊断肺结核的患者数来统计涂片法、培养法以及BALF Xpert MTB/RIF检验的各自结核发现率.结果 69例痰结核菌涂片阴性患者中最终确诊为肺结核54例,确诊的54例痰结核菌涂片阴性肺结核患者中,支气管肺泡灌洗液(bronchoalceolar lavage fluid BALF)Xpert MTB/RIF试验阳性33例占61.11%(33/54).其中35例涂阴培阴患者中17例灌洗液Xpert MTB/RIF阳性,能提高菌阴结核发现率31.48%(17/54);19例涂阴培阳患者中,16例灌洗液Xpert MTB/RIF阳性,与培养法符合率84.21%(16/19).BALFXpert MTB/RIF检验的肺结核发现率61.11%(33/54),培养法肺结核发现率35.19%(19/54).Xpert法与培养法比较,差异有统计学意义(P<0.05).文献报告大于50%,也有达到80%的,与选例有很大关系.2例灌洗液涂阳培阳患者Xpert MTB/RIF检验均阳性符合率100%.结论 对BALF做Xpert MTB/RIF试验是一种简便、快速、准确的方法,且能够提高菌阴(即痰涂阴培阴)肺结核患者发现率48.75%,对痰涂片阴性的发现率提高59.62%(14+17/35+17),明显优于痰涂片及培养法.%Objective To compare the detection rate of Xpert MTB/RIF test and sputum smear and culture method, and to investigate the value of the detection of the smear negative pulmonary tuberculosis.Methods 69 patients with tuberculosis diagnosed in Tianjin Haihe Hospital from July 2014 to July 2015 were examined by fiberoptic bronchoscopy ( and check of tubercle bacillus in sputum smear negative three times ) .With final diagnosis of pulmonary tuberculosis patients the number of statistical smear, culture method and Xpert MTB/RIF test their tuberculosis detection rate.Results A total of 69 patients with sputum smear negative patients with final diagnosis of 54 cases of pulmonary tuberculosis, confirmed 54 cases of tubercle bacillus in sputum smear negative pulmonary tuberculosis patients, Xpert MTB/RIF test was positive in 33 cases accounted for 61.11%(33/54).Among the 35 cases, 17 patients with Xpert MTB/RIF positive, can improve the detection rate of bacterial negative tuberculosis 31.48%(17/54), 19 cases of patients with negative smear positive, 16 cases of Xpert MTB/RIF positive, and the culture method was 84.21%(16/19).BALFXpert MTB/RIF test of tuberculosis found in 61.11%(33/54), the culture method of tuberculosis found 35.19%(19/54).The report is more than 50%, also has reached to 80%, and the selection has a great relationship.Xpert method and culture method, the difference was statistically significant (P<0.05).The positive rate of Xpert test was positive in 2 cases of positive MTB/RIF in the patients with positive smear positive 100%.Conclusion It is a simple, rapid and accurate method to do Xpert MTB/RIF test for BALF, and it can improve the smear negative tuberculosis patients found rate of 48.75%.The positive rate of the sputum smear negative is 59.62%(14+17/35+17), which is better than that of sputum smear and culture.