GeneXpert MTB/RIF检测粪便标本对肠结核的诊断价值

doi:10.19983/j.issn.2096-8493.20220119

摘要/Abstract

摘要：

目的: 评价GeneXpert MTB/RIF(简称“Xpert”)检测粪便标本对肠结核患者的诊断价值。方法: 回顾性分析2019年8月至2022年5月陕西省结核病防治院收治的同时采用浓缩集菌漂浮法镜检(简称“集菌法”)、BACTEC MGIT 960液体培养(简称“MGIT 960培养”)和Xpert检测的98例疑似肠结核患者粪便标本实验室资料。以最终临床诊断为参考标准,评价3种方法检测粪便标本对肠结核的诊断效能。结果: 98例疑似肠结核患者中,确诊为肠结核54例(55.1%)、非肠结核44例(44.9%)。GeneXpert对肠结核的阳性检出率[38.8%(38/98)]明显高于集菌法[15.3%(15/98)]和MGIT 960培养[16.3%(16/98)],差异均有统计学意义(χ²=25.496,P=0.000;χ²=20.224,P=0.000)。且Xpert对集菌法和(或)MGIT 960培养阳性肠结核患者粪便标本的阳性检出率为95.5%(21/22),对二者均阴性粪便样本的阳性检出率为53.1%(17/32)。以临床诊断为参照,集菌法、MGIT 960培养和Xpert检测的敏感度分别为27.8%(15/54)、29.6%(16/54)和70.4%(38/54),特异度分别为97.7%(43/44)、100.0%(44/44)和90.9%(40/44),符合率分别为59.2%(58/98)、61.2%(60/98)和79.6%(78/98),Kappa值分别为0.24、0.27和0.60。结论: Xpert检测粪便的敏感度和Kappa值均高于集菌法和MGIT 960培养,与临床诊断一致性较好,可为早期诊断肠结核提供诊断依据。

关键词: 结核,肠, 粪便, 分子诊断技术, 诊断, 对比研究

Abstract:

Objective: To evaluate the diagnostic value of GeneXpert MTB/RIF (Xpert) detection of stool samples in patients with intestinal tuberculosis. Methods: The laboratory data of stool specimens from 98 patients with suspected intestinal tuberculosis admitted to Shaanxi Provincial Hospital of Tuberculosis Prevention and Treatment from August 2019 to May 2022 were retrospectively analyzed, which included test data detected by concentrated collection of bacteria floating method (referred to as “collection method”), BACTEC MGIT 960 liquid culture (referred to as “MGIT 960 culture”) and Xpert method simultaneously. Taking the final clinical diagnosis as the reference standard, the diagnostic efficacy of the three methods for detecting fecal specimens for intestinal tuberculosis was evaluated. Results: Of the 98 patients with suspected intestinal tuberculosis, 54 (55.1%) patients were confirmed intestinal tuberculosis, and 44 (44.9%) were non-intestinal tuberculosis. The positive detection rates of bacterial Xpert method (38.8% (38/98)) was apparently higher than collection method (15.3% (15/98)) and MGIT 960 culture (16.3% (16/98)), respectively. The differences were all statistically significant (χ²=25.496, P=0.000; χ²=20.224, P=0.000). The positive detection rate of stool samples positive for smear and/or culture was 95.5% (21/22), and the positive detection rate of stool samples negative for both smear and culture was 53.1% (17/32). Taking clinical diagnosis as reference, the sensitivity of collection method, MGIT 960 culture and Xpert method were 27.8% (15/54), 29.6% (16/54) and 70.4% (38/54), respectively, and the specificity was 97.7% (43/44), 100.0% (44/44) and 90.9% (40/44), the coincidence rates were 59.2% (58/98), 61.2% (60/98) and 79.6% (78/98), respectively, the Kappa values were 0.24, 0.27, and 0.60, respectively. Conclusion: The sensitivity and Kappa values of Xpert method for detecting feces are higher than that of collection method and MGIT 960 culture, which is consistent with clinical diagnosis. Xpert method can provide a diagnostic basis for early diagnosis of intestinal tuberculosis.

Key words: Intestinal tuberculosis, Feces, Molecular diagnostic techniques, Diagnostic, Comparative studies

中图分类号:

R52
R115

李静, 梁亚萍, 邹远妩, 张思琪, 郑见宝, 仵倩红. GeneXpert MTB/RIF检测粪便标本对肠结核的诊断价值[J]. 结核与肺部疾病杂志, 2022, 3(5): 382-387. doi: 10.19983/j.issn.2096-8493.20220119

Li Jing, Liang Yaping, Zou Yuanwu, Zhang Siqi, Zheng Jianbao, Wu Qianhong. The diagnostic value of stool samples detected by GeneXpert MTB/RIF for intestinal tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(5): 382-387. doi: 10.19983/j.issn.2096-8493.20220119

图/表 1

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检测方法	临床诊断(例)		敏感度 (95%CI;%)	特异度 (95%CI;%)	阳性预测值 (95%CI;%)	阴性预测值 (95%CI;%)	符合率 (95%CI;%)	Kappa值
检测方法	肠结核 (54例)	非肠结核 (44例)	敏感度 (95%CI;%)	特异度 (95%CI;%)	阳性预测值 (95%CI;%)	阴性预测值 (95%CI;%)	符合率 (95%CI;%)	Kappa值
集菌法			27.8(15.8~ 39.7)	97.7(93.3~ 100.0)	93.8(81.9~ 100.0)	52.4(41.6~ 63.2)	59.2(49.5~ 68.9)	0.24
阳性	15	1
阴性	39	43
MGIT 960培养			29.6(17.5~ 41.8)	100.0(100.0~ 100.0)	100.0(100.0~ 100.0)	53.7(42.9~ 64.5)	61.2(51.6~ 70.9)	0.27
阳性	16	0
阴性	38	44
Xpert			70.4(58.2~ 82.5)	90.9(82.4~ 99.4)	90.5(81.6~ 99.4)	71.4(59.6~ 83.3)	79.6(71.6~ 87.6)	0.60
阳性	38	4
阴性	16	40