摘要
目的:探讨RNA恒温扩增实时检测方法(TB-RNA)和Gen-Xpert MTB/RIF在糖尿病并发肺结核的诊断价值。方法:收集确诊糖尿病并发肺结核住院患者131例的痰液,同时进行抗酸染色法、BACTEC MGIT 960分枝杆菌液体培养(简称MGIT 960)、TB-RNA、Gen-Xpert MTB/RIF,比较各种检测方法的阳性率;并以MGIT 960为金标准,评价TB-RNA和Gen-Xpert MTB/RIF的灵敏度、特异度、阳性预测值、阴性预测值及Kappa(K)值。结果:131例确诊糖尿病并发肺结核患者涂片抗酸染色阳性率为37.40%(49/131),MGIT 960阳性率为57.25%(75/131),TBRNA阳性率为52.25%(69/131),Gen-Xpert MTB/RIF阳性率为60.31%(79/131),4种检测方法阳性率比较差异有统计学意义(χ~2=16.268,P=0.000)。以MGIT 960为阳性对照,抗酸染色法、TB-RNA、Gen-Xpert MTB/RIF在肺结核并发糖尿病患者中的敏感度分别为40.00%、81.33%、97.33%,特异度分别为66.07%、85.71%、89.29%,阳性预测值分别为61.22%、88.41%、92.41%;阴性预测值分别为45.12%、77.42%、96.15%;Kappa(K)值分别为0.058、0.661、0.874。曲线下面积分别为0.548、0.853、0.933;结论:以MGIT 960为金标准,Gen-Xpert MTB/RIF检测灵敏度、特异度较高,曲线下面积最大,与痰结核分枝杆菌培养结果的一致性最高;TB-RNA法次之。TB-RNA和Gen-Xpert MTB/RIF检测对糖尿病并发肺结核均有良好的诊断价值。TB-RNA和Gen-Xpert MTB/RIF检测相结合,可以提高糖尿病并发肺结核患者的早期诊断。
Objective： To evaluate the diagnostic efficiency of TB-RNA and Gen- Xpert MTB/RIF of pulmonary tuberculosis in patients with diabetes mellitus. Methods： 131 patients with confirmed pulmonary tuberculosis complicated with diabetes mellitus were collected,samples test acid fast bacilli（AFB）,BACTEC MGIT 960 （shortened as “MGIT 960”hereafter）,TB-RNA, Gen - Xpert MTB/RIF approaches. With MGIT 960 as golden standard,the sensitivity , specificity , positive predictive value and negative predictive value of four measurement were compared. Results： The positive rates of AFB,MGIT 960,TB-RNA, Gen - Xpert MTB/RIF were 37.40%（49/ 131）;57.25%（75/131）;52.25%（69/131）;60.31%（79/131）of confirmed pulmonary tuberculosis in patients with diabetes mellitus. The difference being significant （χ 2=16.268, P =0.000）.With MGIT 960 as golden standard, the sensitivity of AFB, TB-RNA, Gen - Xpert MTB/RIF were 40.00%, 81.33%, 97.33%; the specificity were 66.07%, 85.71%, 89.29%; the positive predictive value were 61.22%, 88.41%, 92.41%; the negative predictive value were 45.12%,77.42%,96.15%;the Kappa（K） value were 0.058, 0.661,0.874; the Area Under Curve were 0.548,0.853,0.933. Conclusion ：With MGIT 960 as golden standard,Gen - Xpert MTB/RIF demonstrated highest sensitivity, specificity and Area Under Curve,the second was TB-RNA.The two detection methods showesd good results of pulmonary tuberculosis in patients with diabetes mellitus. The combination of TB-RNA and Gen -Xpert MTB/RIF will improve the diagnosis of pulmonary tuberculosis in patients with diabetes mellitus.
作者
刘莉
周祎
张宁
甘昭平
Liu Li;Zhou Yi;Zhang Ning(The Tuberculosis Prevention and Care Hospital in Shaanxi Province（Xi＇an 710100)
出处
《陕西医学杂志》
CAS
2018年第12期1651-1654,共4页
Shaanxi Medical Journal
