mtb检出_Xpert MTB/RIF在儿童肺结核肺泡灌洗液检测中的应用

摘要

目的:评价肺泡灌洗液结核分枝杆菌rpoB基因和半巢式全自动实时荧光定量PCR检测(Xpert MTB/RIF)、结核杆菌BACTEC MGIT960液体快速培养与抗酸染色涂片镜检对儿童肺结核的诊断价值。方法:选择2017年8月至2019年8月于我中心住院的128例初治菌阴肺结核患儿,收集支气管肺泡灌洗液(BALF),行Xpert MTB/RIF、BACTEC MGIT960液体快速培养及抗酸染色涂片镜检。结果:Xpert MTB/RIF、BACTEC MGIT960液体快速培养、抗酸染色涂片镜检,检测阳性率分别为48.44%、22.66%、11.72%;Xpert MTB/RIF法阳性率明显高于培养法及涂片镜检法(P<0.01)。以结核菌培养药敏试验结果为金标准,Xpert MTB/RIF法检测利福平耐药的灵敏度、特异度分别为83.33%、95.65%,两者有较高的一致性。结论:3种实验室检测方法均适用于儿童肺结核的诊断,其中Xpert MTB/RIF法阳性检出率最高,并具有更高的灵敏度,且检测速度快,同时能检测利福平的耐药性,适用于儿童肺结核的快速诊断。

Objective:To evaluate the value of rpoB gene and mutation detection technique(Xpert MTB/RIF), BACTEC MGIT 960 rapid culture and acid fast staining smear microscopy for the detection of bronchoalveolar lavage fluid(BALF)in the diagnosis of pulmonary tuberculosis in children.Methods:From August 2017 to August 2019, 128 acid-fast bacillus negative children with pulmonary tuberlocosis initially treated and hospitalized in our center were selected to collect the BALF for Xpert MTB/RIF, BACTEC MGIT 960 rapid culture and acid fast staining smear microscopy.Results:The positive rates of Xpert MTB/RIF, BACTEC MGIT960 rapid culture and acid fast staining smear were 48.44%, 22.66% and 11.72%, respectively;the positive rate of Xpert MTB/RIF method was significantly higher than that of culture method and smear microscopy method(P<0.01). Using drug susceptibility test results of Mycobacterium tuberculosis culture as gold standard, the sensitivity and specificity of Xpert MTB/RIF for rifampicin resistance were 83.33% and 95.65%, respectively;there was a high consistency between the two.Conclusion:Three kinds of laboratory test methods are suitable for the diagnosis of pulmonary tuberculosis in children. Of them, the Xert MTB/RIF method has the highest positive detection rate, higher sensitivity and faster detection speed. It can also detect rifampicin resistance, which is suitable for the rapid diagnosis of pulmonary tuberculosis in children.