摘要
目的探讨利福平耐药实时荧光定量核酸扩增技术(Xpert MTB/RIF)联合结核感染T细胞斑点试验(TSPOT.TB)对结核性脑膜炎早期诊断的临床价值。方法收集2019年10月至2022年9月于河南省胸科医院就诊的疑似结核性脑膜炎患者90例,经确诊分为脑膜炎组(46例)和非脑膜炎组(44例)。所有研究对象进行脑脊液抗酸杆菌涂片、脑脊液Xpert MTB/RIF和外周血T-SPOT.TB检测,比较各单一检测方法和联合检测的诊断阳性率、阴性率和准确率,采用灵敏度、特异度、阳性预测值、阴性预测值和受试者工作特征曲线对各检测方法的诊断价值进行评价。结果TSPOT.TB和Xpert MTB/RIF单一检测诊断阳性率(分别为69.57%和60.87%)均高于涂片抗酸染色(19.57%),TSPOT.TB与Xpert MTB/RIF并联检测诊断阳性率(89.13%)高于串联检测(60.87%)和所有单一检测方法,差异有统计学意义(P<0.05)。并联检测诊断准确率(90.00%)高于串联检测(78.89%)和Xpert MTB/RIF检测(77.78%),差异有统计学意义(P<0.05)。并联检测对结核性脑膜炎诊断的灵敏度和阴性预测值达到89.13%和88.89%,均高于串联检测和单一检测方法;特异度和阳性预测值分别为90.91%和91.11%,与串联检测和单一检测方法差异无统计学意义(P>0.05);曲线下面积最高,达到0.900(95%CI:0.828~0.972)。结论TSPOT.TB与Xpert MTB/RIF检测用于结核性脑膜炎诊断,相比较传统方法具有较好的敏感度和特异度,采取并联检测方式能够显著提高结核性脑膜炎的诊断效能,有利于早期诊断和治疗。
Objective To explore the clinical value of Xpert Mycobacterium tuberculosis/rifampin(Xpert MTB/RIF)combined with T-cells enzyme linked immunospot(TSPOT.TB)in early diagnosis of tuberculous meningitis.Methods A total of 90 suspected tuberculous meningitis patients admitted to Henan Chest Hospital from October 2019 to September 2022 were collected.They were classified into meningitis group(46 cases)and non-meningitis group(44 cases).Cerebrospinal fluid acid-fast staining,cerebrospinal fluid Xpert MTB/RIF and peripheral blood T-SPOT.TB were tested for all subjects.The diagnostic positive rate,negative rate and accuracy rate of each single detection method and combined detection were compared.Sensitivity,specificity,positive predictive value,negative predictive value and receiver operating characteristic curve were evaluated the diagnostic value of each detection method.Results The positive rates of TSPOT.TB and Xpert MTB/RIF(69.57% and 60.87%)were higher than those of acid-fast staining(19.57%).The diagnostic positive rate of parallel detection of TSPOT.TB and Xpert MTB/RIF(89.13%)was higher than those of series detection(60.87%)and all single detection methods(P<0.05).The diagnostic accuracy of parallel detection(90.00%)was higher than those of series detection(78.89%)and Xpert MTB/RIF detection(77.78%)(P<0.05).The sensitivity and negative predictive value of parallel detection for tuberculous meningitis were 89.13% and 88.89%,respectively,which were higher than those of serial detection and single detection.The specificity and positive predictive value of parallel detection were 90.91% and 91.11%,respectively,which were not different from the series detection and single detection methods.Area under curve area of parallel detection was the highest,reaching 0.900(95%CI:0.828-0.972).Conclusion TSPOT.TB and Xpert MTB/RIF are used in the diagnosis of tuberculous meningitis.Compared with traditional methods,they have better sensitivity and specificity.Parallel detection can significantly improve the diagnostic efficiency of tuberculous meningitis,which is conducive to early diagnosis and treatment.
作者
邝红萍
李健康
贾要丽
袁彦丽
张博
彭强
许路阳
周晓蕾
KUANG Hongping;LI Jiankang;JIA Yaoli;YUAN Yanli;ZHANG Bo;PENG Qiang;XU Luyang;ZHOU Xiaolei(Third Ward of Pulmonary and Critical Care Medicine,Henan Chest Hospital,Zhengzhou 450000,China;Department of Severe Tuberculosis,Henan Chest Hospital,Zhengzhou 450000,China)
出处
《河南医学研究》
CAS
2024年第13期2351-2354,共4页
Henan Medical Research
基金
2020年河南省医学科技攻关计划联合共建项目(LHGJ20200229)。
