4种检测方法在肺结核诊断中的诊断效能评价

Diagnostic efficacy of four detection methods in diagnosis of pulmonary tuberculosis

    摘要
  • 摘要:
    目的 评估涂片抗酸染色、分枝杆菌培养、结核感染T细胞斑点试验（T-SPOT.TB）和结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术（GeneXpert MTB/RIF）及其联合检测在诊断肺结核中的价值。
    方法 收集2021年5月－2023年6月复旦大学附属中山医院同时送检抗酸涂片、分枝杆菌培养、T-SPOT.TB和GeneXpert MTB/RIF的疑似肺结核患者的检测结果，共纳入临床确诊肺结核患者392例，非结核患者1 851例。以临床诊断为金标准，计算上述4种方法及其联合检测的灵敏度、特异性、阳性预测值、阴性预测值、准确率并绘制受试者工作特征（ROC）曲线，评估4种方法单独或联合应用诊断肺结核的效能。
    结果 抗酸涂片、分枝杆菌培养、T-SPOT.TB和GeneXpert MTB/RIF检测的灵敏度分别为13.01%、53.83%、91.84%和57.65%；特异性分别为98.11%、100.00%、73.20%和99.84%；ROC曲线下面积（AUC）分别为0.556、0.769、0.825和0.787。T-SPOT.TB的检测灵敏度及AUC高于其他3种方法（P＜0.05）。T-SPOT.TB联合GeneXpert MTB/RIF的AUC最高（0.847）（P＜0.001）。
    结论 T-SPOT.TB具有高灵敏度，可用于肺结核初筛；GeneXpert MTB/RIF具有高特异性，可作为肺结核首选的病原学诊断方法；T-SPOT.TB和GeneXpert MTB/RIF联合检测有助于提高肺结核的诊断效能。

     

    Abstract:
    OBJECTIVE  To evaluate the values of smear acid-fast staining, mycobacterium culture, T-cell spot test for tuberculosis infection (T-SPOT.TB) and Mycobacterium tuberculosis/rifampicin resistance real-time fluorescent quantitative nucleic acid amplification detection technology (GeneXpert MTB/RIF), as well as their combined detection, in the diagnosis of pulmonary tuberculosis.
    METHODS  The detection results of suspected pulmonary tuberculosis patients who simultaneously underwent acid-fast smear, mycobacterium culture, T-SPOT.TB and GeneXpert MTB/RIF tests at Zhongshan Hospital, Fudan University from May 2021 to Jun. 2023 were collected. A total of 392 clinically confirmed pulmonary tuberculosis patients and 1 851 non-tuberculosis patients were included. With clinical diagnosis as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the aforementioned four methods and their combined detection were calculated, and the receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of the four methods alone or in combination in the diagnosis of pulmonary tuberculosis.
    RESULTS The sensitivities of acid-fast smear, mycobacterium culture, T-SPOT.TB and GeneXpert MTB/RIF detection were 13.01%, 53.83%, 91.84% and 57.65%, respectively. The specificities were 98.11%, 100.00%, 73.20% and 99.84%, respectively. The areas under the ROC curve (AUC) were 0.556, 0.769, 0.825 and 0.787, respectively. The detection sensitivity and AUC of T-SPOT.TB were both higher than those of the other three methods (P＜0.05). The combined use of T-SPOT.TB and GeneXpert MTB/RIF yielded the highest AUC (0.847) (P＜0.001).
    CONCLUSIONS T-SPOT.TB exhibits high sensitivity and can be used for initial screening of pulmonary tuberculosis. GeneXpert MTB/RIF demonstrates high specificity and can serve as the preferred etiological diagnostic method for pulmonary tuberculosis. The combined detection of T-SPOT.TB and GeneXpert MTB/RIF contributes to improving the diagnostic efficacy of pulmonary tuberculosis.

     

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