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目的探讨Xpert MTB/RIF对胸水中结核分枝杆菌的检出情况,评价其在结核性胸膜炎早期诊断中的应用价值。方法对102例结核性胸膜炎患者和50例恶性胸水患者的胸水进行Xpert MTB/RIF检测,同时行胸水抗酸染色及结核分枝杆菌快速培养和药敏试验(BACTECT MGIT 960),比较Xpert MTB/RIF与抗酸染色、结核分枝杆菌快速培养在敏感性及特异性上的差异,评价Xpert MTB/RIF在结核性胸膜炎诊断中的应用价值。结果 102例结核性胸水标本中,4例抗酸染色阳性,阳性率为3.92%(4/102);18例BACTECT MGIT 960培养阳性,阳性率为17.65%(18/102);24例Xpert MTB/RIF检测结核分枝杆菌阳性,阳性率为23.53%(24/102),其中,3例存在利福平耐药突变基因,耐药突变率为12.50%(3/24)。Xpert MTB/RIF检测结核分枝杆菌的阳性率高于抗酸染色法,差异有统计学意义(P<0.05),与结核分枝杆菌快速培养阳性率及利福平药敏结果差异无统计学意义(P>0.05)。50例恶性胸水标本抗酸染色及结核分枝杆菌快速培养均为阴性,特异性均为100%,1例Xpert MTB/RIF检测结核分枝杆菌阳性,特异性为98.00%,其特异性与抗酸染色及结核分枝杆菌快速培养差异无统计学意义(P>0.05)。结论 Xpert MTB/RIF系统在结核性胸膜炎的快速诊断中具有较高的诊断能力,是一种省时、敏感性和特异性均高的结核分枝杆菌检测方法。
Objective To investigate the detection of Mycobacterium tuberculosis in pleural effusion by Xpert MTB / RIF and to evaluate its value in the early diagnosis of tuberculous pleurisy. Methods Xpert MTB / RIF was used to detect pleural effusion in 102 cases of tuberculous pleurisy and 50 cases of malignant pleural effusion. Meanwhile, the antitumor of pleural effusion and rapid culture of Mycobacterium tuberculosis were also detected by Xpert MTB / RIF assay (BACTECT MGIT 960) RIF and acid-fast staining, rapid detection of Mycobacterium tuberculosis in sensitivity and specificity differences, evaluation of Xpert MTB / RIF in the diagnosis of tuberculous pleurisy value. Results Among the 102 cases of tuberculous pleural effusion, 4 cases were positive for acid-fast staining and the positive rate was 3.92% (4/102). The positive rate of BACTECT MGIT 960 was 17.65% (18/102) in 18 cases, and 24 cases of Xpert MTB / RIF test positive for Mycobacterium tuberculosis, the positive rate was 23.53% (24/102), of which 3 cases of rifampicin resistance mutations exist, the rate of drug-resistant mutation was 12.50% (3/24). Xpert MTB / RIF detection of Mycobacterium tuberculosis positive rate was higher than acid-fast staining, the difference was statistically significant (P <0.05), and Mycobacterium tuberculosis rapid culture positive rate and rifampicin susceptibility results no statistical difference Significance (P> 0.05). 50 cases of malignant pleural effusion acid-fast staining and rapid culture of Mycobacterium tuberculosis were negative, the specificity was 100%, 1 case of Xpert MTB / RIF detection of Mycobacterium tuberculosis positive, specificity was 98.00%, its specificity and resistance There was no significant difference in acid staining and rapid culture of Mycobacterium tuberculosis (P> 0.05). Conclusion The Xpert MTB / RIF system has high diagnostic ability in the rapid diagnosis of tuberculous pleurisy. It is a time-saving, sensitive and specific detection method of Mycobacterium tuberculosis.