四种检测方法在结核病诊断中的比较

周秋菊 王冬莲 杨阳 涂茜 石庆新

[摘要] 目的 比較分析MGIT960液体培养法、结核/非结核分枝杆菌核酸检测（PCR-荧光探针法）、Xpert MTB/RIF和直接涂片镜检在结核病诊断中的应用。 方法 收集我院2019年5～12月临床上疑似为结核病患者的各类标本。将疑似结核病患者2天内所有的标本混匀后进行直接涂片镜检，然后平均分装为3份，进行MGIT960液体培养、PCR-荧光探针法和Xpert MTB/RIF。 结果 2019年5～12月间总共收集了我院710份疑似结核病患者的各类标本。直接涂片镜检、PCR-荧光探针法、MGIT960液体培养和Xpert MTB/RIF检测结核分枝杆菌的阳性率分别为12.0%、18.7%、21.4%和24.8%。以临床诊断作为参考标准时，直接涂片法、PCR-荧光探针法、MGIT960液体培养和Xpert MTB/RIF检出结核分枝杆菌的灵敏度分别为40.2%、60.3%、78.4%和70.1%，而特异度分别为98.6%、96.9%、100.0%和92.2%，且四种方法组间比较均具有统计学差异。 结论 四种临床检测方法在结核病诊断中各有优缺点，联合应用可以更好的诊断、治疗和监测结核病。

[关键词] 结核病;Xpert MTB/RIF;PCR-荧光探针法;MGIT960液体培养法

[中图分类号] R52          [文献标识码] A          [文章编号] 1673-9701（2020）16-0008-05

Comparison of four detection methods in the diagnosis of tuberculosis

ZHOU Qiuju   WANG Donglian   YANG Yang   TU Xi   SHI Qingxin

Department of Clinical Laboratory， Enze Hospital， Taizhou Enze Medical Center（Group）， Taizhou  318050， China

[Abstract] Objective To compare and analyze the application of MGIT960 liquid culture method， tuberculosis/non-tuberculous nucleic acid detection（PCR-fluorescent probe method）， Xpert MTB/RIF and direct smear microscopy in the diagnosis of tuberculosis. Methods Various specimens from clinically suspected tuberculosis patients in our hospital from May to December 2019 were collected. All specimens from suspected tuberculosis patients were mixed in two days， then directly smeared for microscopy， and then divided into three equal parts for MGIT960 liquid culture， PCR-fluorescent probe method and Xpert MTB/RIF. Results A total of 710 specimens of suspected tuberculosis patients were collected from our hospital from May 2019 to December 2019. The positive rates of direct smear microscopy， PCR-fluorescent probe method， MGIT960 liquid culture and Xpert MTB/RIF detection of Mycobacterium tuberculosis were 12.0%， 18.7%， 21.4% and 24.8%， respectively. Taking clinical diagnosis as the reference standard， the sensitivity of detecting Mycobacterium tuberculosis by direct smear method， PCR-fluorescent probe method， MGIT960 liquid culture， and Xpert MTB/RIF was 40.2%， 60.3%， 78.4%， and 70.1%， respectively， and the specificity was 98.6%， 96.9%， 100.0%， and 92.2%， respectively， and the differences were statistically significant. Conclusion The four clinical detection methods have their own advantages and disadvantages in the diagnosis of tuberculosis， and the combined application can better diagnose， treat and monitor tuberculosis.

[Key words] Tuberculosis; Xpert MTB/RIF; PCR-fluorescent probe method; MGIT960 liquid culture method

结核病（Tuberculosis，TB）是由结核分枝杆菌引起的慢性传染病，是全球死亡人数最多的单一病原体所致的传染病，也是全球十大死因之一。主要通过飞沫传播，可引起肺结核和肺外结核。大约90%为成年人，男女比例为2：1。在全球范围内，2018年估计新发结核病患者约1000万（900～1110万），结核病死亡人数约124万，利福平耐药结核病患者约48.4万，其中耐多药结核病患者约占78%[1]。2015～2018年间结核病的发病率累计降幅为6.3%，死亡率减少了11%[1]，远低于《终止结核病策略》的目标，因此终止结核病的任务还是非常艰巨的。……