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目的:评价Xpert Mtb/RIF检测技术对颈部淋巴结核病的诊断价值。方法:收集武汉市肺科医院2015-01-2016-06期间病理确诊的颈部淋巴结核病患者的颈部淋巴结手术活检组织标本,对标本分别进行抗酸染色法、结核杆菌DNA荧光定量PCR[TB-DNA,阳性标本进行线性探针法(LPA)]及固体培养法(培养阳性进行菌型鉴定及药物敏感试验检测)和Xpert Mtb/RIF检测inhA、katG、rpoB耐药基因并进行比较。采用SPSS 17.0软件进行统计分析。结果:颈部淋巴结标本以病理确诊淋巴结核病为标准,抗酸染色法敏感度为8.12%(13/160)、TB-DNA敏感度为69.38%(111/160)、固体培养法敏感度为31.88%(51/160),Xpert Mtb/RIF敏感度为74.38%(119/160)。联合Xpert Mtb/RIF、LPA和固体培养加药敏试验检出耐多药淋巴结核病的检出率为9.38%(15/160)。结论:Xpert Mtb/RIF可快速检出颈部淋巴结组织结核分枝杆菌及其利福平耐药性,TB-DNA检测颈部淋巴结标本具有与Xpert Mtb/RIF相似的敏感度,且通过LPA技术可同时检测异烟肼和利福平的耐药基因,该2种方法均优于传统培养及涂片法。
Objective: To evaluate the diagnostic value of Xpert Mtb / RIF in the diagnosis of cervical lymphadenopathy. Methods: The cervical lymph node biopsy specimens from patients with pathologically confirmed cervical lymph node tuberculosis were collected from Wuhan Pulmonary Hospital from January 2015 to June 2016. The specimens were stained with acid-fast staining, (LPA)] and solid culture method (culture positive for bacterial identification and drug sensitivity test) and Xpert Mtb / RIF detection of inhA, katG, rpoB resistance genes and compared. SPSS 17.0 software for statistical analysis. Results: The cervical lymph node specimens were pathologically diagnosed as lymphadenopathy. The sensitivity of acid-fast staining was 8.12% (13/160), the sensitivity of TB-DNA was 69.38% (111/160), and the sensitivity of solid culture was 31.88 % (51/160), Xpert Mtb / RIF sensitivity was 74.38% (119/160). In combination with Xpert Mtb / RIF, LPA and solid culture plus drug susceptibility tests, the detection rate of MDR-TB was 9.38% (15/160). Conclusion: Xpert Mtb / RIF can detect Mycobacterium tuberculosis and rifampicin resistance in cervical lymph nodes rapidly. TB-DNA detection of cervical lymph node specimens has similar sensitivity to Xpert Mtb / RIF, Both isoniazid and rifampicin resistance genes can be detected simultaneously, both of which are superior to traditional culture and smear methods.