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目的探讨结核分枝杆菌rpo B基因和突变检测(Xpert~MTB/RIF)在结核性胸膜炎诊断中的临床应用价值。方法选取208例疑似结核性胸膜炎的痰涂片阴性患者,常规进行胸水涂片、胸水固体培养、淋巴细胞百分比、胸水腺苷脱氨酶(ADA)及胸水Xpert~MTB/RIF检测。结果以随访后临床诊断结果为金标准,Xpert~MTB/RIF检测灵敏度显著高于涂片镜检,差异有统计学意义(P<0.01),与固体培养比较差异无统计学意义(P>0.05)。胸水ADA与胸水Xpert~MTB/RIF联合检测,其灵敏度为91.4%,特异度为57.0%,阳性预测值为72.4%,阴性预测值为84.1%。淋巴细胞百分比、胸水ADA与胸水Xpert~MTB/RIF半定量结果ΔCt循环数呈负相关(r值分别为-0.337、-0.249,P<0.05)。胸水涂阳组ΔCt循环数低于胸水涂阴组,胸水菌阳组ΔCt循环数低于胸水菌阴组,差异均有统计学意义(P<0.05)。治疗1个月时,Xpert~MTB/RIF阳性组总有效率明显低于阴性组,差异有统计学意义(P<0.05)。结论 Xpert~MTB/RIF有助于提高结核性胸膜炎检出率,可作为临床重要的辅助鉴别诊断方法。
Objective To investigate the clinical application value of Mycobacterium tuberculosis rpo B gene and mutation detection (Xpert ~ MTB / RIF) in the diagnosis of tuberculous pleurisy. Methods Totally 208 sputum smear-negative patients with suspected tuberculous pleurisy were enrolled in the study. Pleural effusion, solid pleural fluid culture, lymphocyte percentage, adenosine deaminase (ADA) and pleural effusion Xpert ~ MTB / RIF were detected routinely. Results The follow-up results of clinical diagnosis were the gold standard. The detection sensitivity of Xpert ~ MTB / RIF was significantly higher than that of smear microscopy (P <0.01), but there was no significant difference compared with solid culture (P> 0.05). The combined detection of pleural effusion ADA and pleural effusion Xpert ~ MTB / RIF, the sensitivity was 91.4%, the specificity was 57.0%, the positive predictive value was 72.4%, the negative predictive value was 84.1%. The percentage of lymphocytes and pleural effusion ADA was negatively correlated with the number of ΔCt cycles in pleural effusion Xpert ~ MTB / RIF semiquantitative results (r values -0.337, -0.249, P <0.05, respectively). The number of ΔCt cycles in pleural effusion smear group was lower than that in pleural effusion smear negative group, and the number of ΔCt cycles in pleural effusion pleural effusion group was lower than that in pleuropulmonary smear negative group (P <0.05). At 1 month, the total effective rate of Xpert ~ MTB / RIF positive group was significantly lower than that of negative group, the difference was statistically significant (P <0.05). Conclusion Xpert ~ MTB / RIF can help increase the detection rate of tuberculous pleurisy, which can be used as a clinically important auxiliary differential diagnosis method.