4种检测方法在肺结核诊断中的诊断效能评价

Diagnostic efficacy of 4 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 value 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 4 methods and their combined detection were calculated, and the receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of the 4 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 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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