GeneXpert MTB/RIF在检测系统性自身免疫病合并肺结核患者中的应用

目的 评价GeneXpert MTB/RIF系统在诊断系统性自身免疫病（SAD）合并肺结核（MTB）患者中的应用价值。方法 对临床诊断和影像学检查确诊的350例系统性自身免疫病合并肺结核患者和50例系统性自身免疫病非结核对照组患者的痰标本进行GeneXpert MTB/RIF检测,评价GeneXpert MTB/RIF诊断性能,并与结核菌培养、T-SPOT法、抗酸涂片染色法等比较,判断优劣以及半定量检测结核菌的效能。以结核菌液体药敏法为标准,分析GeneXpert MTB/RIF检测利福平耐药的敏感度和特异度。结果 GeneXpert MTB/RIF、结核菌培养、T-SPOT法、抗酸涂片染色法4种方法检测的灵敏度分别为95.14%、84.00%、89.71%和56.86%,特异度分别为100.00%,92.00%,84.00%,100.00%。GeneXpert MTB/RIF系统灵敏度与T-SPOT比较差异无统计学意义（χ² =4.21,P>0.05）,高于抗酸涂片染色法（χ² =36.60,P<0.05）。GeneXpert MTB/RIF检测利福平(RIF)耐药性的灵敏度为86.00%,特异度为90.56%。结论 GeneXpert MTB/RIF与传统的MGIT960液体培养、T-SPOT法和抗酸涂片染色法等联合,可显著提高合并肺结核系统性自身免疫病结核病的检出率。

Evaluation of GeneXpert MTB/RIF assay in detection of systemic autoimmune disease combined with pulmonary tuberculosis

Objective s To evaluate the application value of GeneXpert MTB/RIF system in the diagnosis of systemic autoimmune disease (SAD) combined with pulmonary tuberculosis (PTB). Methods The sputum specimens from 350 cases of SDA combined with PTB confirmed by clinical and imaging examination and 50 healthy controls were detected respectively by using of GeneXpert MTB/RIF, MGIT960, T-SPOT, and acid smear staining methods. Their detection efficacies were calculated and compared. The sensitivity and specificity of GeneXpert to detect rifampicin (RIF) resistance were analyzed according to the standard of drug susceptibility testing of Mycobacterium tuberculosis with liquid medium. Results The sensitivity of GeneXpert MTB/RIF, MGIT960, T-SPOT, acid smear staining methods were 95.14%, 84.00%, 89.71%and 56.86%, and specificity were 100.00%, 92.00%, 84.00%, 100.00%. There was no significant difference between the GeneXpert MTB/RIF and T-SPOT（χ² =4.21, P>0.05）, was significant difference between the GeneXpert MTB/RIF and acid smear staining methods（χ² =36.60, P<0.05）. The sensitivity and specificity of GeneXpert MTB/RIF to RIF resistance based on MGIT960 were respectively 86.00% and 90.56%. Conclusions GeneXpert MTB/RIF assay, as an auxiliary test, was useful in the detection of SAD combined with PTB, compared with the traditional MGIT960 liquid culture, T-SPOT and acid smear staining methods, which can significantly improve the detection rate of tuberculosis complicated with SAD, and is worthy of further promotion.