摘要
目的评价GeneXpert MTB/RIF技术检测脑脊液中的结核分枝杆菌对成年人结核性脑膜炎（TBM）的早期诊断价值.方法 选取西安市胸科医院2015年6月至2016年12月期间诊治的疑似结核性脑膜炎成年患者90例作为研究对象.研究对象均经抗结核药物治疗时间〈2周,年龄≥18岁.收集患者脑脊液样本,分别用抗酸染色法、液体培养法、GeneXpert MTB/RIF技术检测.按照最新的结核性脑膜炎诊断标准,以临床评分≥6分作为参考标准,对研究对象进行分组,评价GeneXpert MTB/RIF技术的诊断价值.结果 90例研究对象中参照临床评分标准,确定为TBM组61例,非TBM组29例.GeneXpert MTB/RIF检测离心脑脊液标本阳性25例,敏感度为41.0%（25/61）,特异度为100.0%（29/29）,阳性预测值为100.0%（25/25）,阴性预测值为44.6%（29/65）.GeneXpert MTB/RIF检测未离心脑脊液标本、液体培养法、抗酸染色法检测TBM的敏感度分别为23.0%（14/61）、18.0%（11/61）、4.9%（3/61）.GeneXpert MTB/RIF检测离心脑脊液标本的敏感度高于检测未离心脑脊液标本、液体培养法及抗酸染色法,差异均有统计学意义（x2=4.56,P=0.033;x2=7.72,P=0.005;x2=22.43,P〈0.05）.25例经GeneXpert MTB/RIF检测离心脑脊液标本阳性患者中检出利福平耐药1例,与传统药敏结果一致.结论 GeneXpert MTB/RIF技术能快速特异地检测脑脊液中结核分枝杆菌,与抗酸染色和液体培养比较具有较高敏感度,其检测的脑脊液标本经离心浓缩处理后可提高其诊断敏感度.
Objective To evaluate the diagnostic value of GeneXpert MTB/RIF for the early diagnosis of tuberculous meningitis in Adults. Methods Ninety predominantly adults with suspected meningitis were screened prospectively from Xi＇an chest hospital between June 2015 and December 2016.All subjects aged ≥18 years were treated with anti-tuberculosis drug for 〈2 weeks.Samples of cerebrospinal fluid were collected and tested by Ziehl-Neelsen staining, MGIT960 liquid culture and GeneXpert MTB/RIF.And the enrolled patients were grouped according to 2010 South African expert consensus.The diagnostic performance of GeneXpert MTB/RIF was evaluated by camparing against clinical scored ≥6 points. Results Of the 90 patients,61 were in TBM group, and 29 were in no-TBM group.Twenty-five positive cases of cerebrospinal fluid （CSF） were tested by GeneXpert MTB/RIF,the sensitivity was 41.0% （25/61）,the specificity was 100.0% （29/29）,the positive predictive value was 100.0% （25/25）,and the negative predictive was 44.6% （29/65）.The sensitivity of GeneXpert MTB/RIF （non-centrifugal CSF）, MGIT 960 liquid culture and Ziehl-Neelsen staining were 23.0% （14/61）, 18.0% （11/61） and 4.9% （3/61）, respectively.Compared with the sensitivity of GeneXpert MTB/RIF （centrifugal CSF）,the significant differencse were found among the sensitivity of GeneXpert MTB/RIF （non-centrifugal CSF）,MGIT 960 liquid culture and Ziehl-Neelsen staining （x2=4.56, P=0.033;x2=7.72, P=0.005;x2=22.43, P〈0.05）.Rifampin resistance was found in 1 case, consistent with traditional drug susceptibility test. Conclusion GeneXpert MTB/RIF is a rapid and specific method to detect MTB in CSF.Compared with Z-N stain and MGIT 960, it has higher sensitivity.After centrifugal CSF, it could improve the sensitivity of diagnosis of TBM.
出处
《中国防痨杂志》
CAS
2017年第9期980-984,共5页
Chinese Journal of Antituberculosis
基金
西安市卫生和计划生育委员会科研项目（J201602017）
关键词
结核
脑膜
核酸扩增技术
早期诊断
利福平
抗药性
Tuberculous,meningeal
Nucleic acid amplification techniques
Early diagnosis
Rifampin
Drug resistance
