目的:分析灌洗液结核分枝杆菌(TB)及利福平耐药快速检测(XpertMTB/RIF)、TB培养及TB脱氧核糖核酸(TB-DNA)检测在肺结核诊断中的应用价值。方法:选取温州市中心医院2018年1月至2020年1月收治且经临床诊断为肺结核的患者75例作为研究对象。以临床诊断结果作为金标准，分析XpertMTB/RIF检测、TB培养及TB-DNA检测肺结核的敏感性、特异性及准确性，并评估TB对利福平耐药性及患者痰中带血、发热等不良反应情况。结果:XpertMTB/RIF检测诊断肺结核的敏感性、特异性、准确性分别为95.24%、72.71%、85.33%；TB培养检测诊断肺结核的敏感性、特异性、准确性分别为80.95%、66.67%、74.67%；TB-DNA检测诊断肺结核的敏感性、特异性、准确性分别为78.57%、69.70%、74.67%。XpertMTB/RIF检测肺结核的敏感性与TB培养检测、TB-DNA检测比较，差异均有统计学意义(χn 2＝4.086、5.126，n P＝0.043、0.024)。以临床诊断结果为金标准，在获取的阳性标本中，XpertMTB/RIF对耐药性检测的灵敏度、特异度分别为72.73%、93.55%；TB培养对耐药性检测的灵敏度、特异度分别为54.55%、74.19%；TB-DNA对耐药性检测的灵敏度、特异度分别为63.64%、70.97%。XpertMTB/RIF对耐药性检测的灵敏度、特异度均高于TB培养与TB-DNA检测，差异均有统计学意义(χn 2＝4.292、5.415，n P＝0.038、0.020)。进行纤维支气管镜检查、肺泡灌洗及刷检过程中，75例患者均未出现严重不良反应，术后可见2例痰中带血、1例发热，以上患者在1～3 d后不良反应均消失。n 结论:XpertMTB /RIF检测、TB培养及TB-DNA检测在肺结核诊断中均有较好的应用价值，但在快速检测肺结核及利福平耐药方面，XpertMTB/RIF检测的准确性更好。“,”Objective:To analyze the application value of XpertMTB/RIF, culture of Mycobacterium tuberculosis (MTB), and detection of Mycobacterium tuberculosis DNA (TB-DNA) in the diagnosis of tuberculosis.Methods:From January 2018 to January 2020, 75 patients admitted to Wenzhou Central Hospital and diagnosed with tuberculosis in clinic were selected in the research.The results of clinical diagnosis were used as the gold standard.The sensitivity, specificity and accuracy of XpertMTB/RIF, TB cultureand TB-DNA in the detection of tuberculosis were analyzed.The resistance of MTB to rifampicin and the adverse reactions such as blood in sputum and fever of patients were evaluated.Results:The sensitivity, specificity and accuracy of XpertMTB/RIF in detecting tuberculosis were 95.24%, 72.71%and 85.33%, respectively.The sensitivity, specificityand accuracy of TB culture in detecting tuberculosis were 80.95%, 66.67% and 74.67%, respectively.The sensitivity, specificity and accuracy of TB-DNA detection in detecting tuberculosis were 78.57%, 69.70%and 74.67%, respectively.There were statistically significant differences in the sensitivity among XpertMTB/RIF, TBand TB-DNA in detecting tuberculosis (χn 2=4.086, 5.126, n P=0.043, 0.024). The result of clinical diagnosis was used as the gold standard.In the positive samples obtained, the sensitivity and specificity of XpertMTB/RIF in detection of drug resistance were 72.73% and 93.55%, respectively.The sensitivity and specificity of TB were 54.55% and 74.19%, respectively, and the sensitivity and specificity of TB-DNA were 63.64% and 70.97%, respectively.The sensitivity and specificity of XpertMTB/RIF in detection of drug resistance were higher than those of TB culture and TB-DNA, and the difference in specificity was statistically significant (χn 2=4.292, 5.415, n P=0.038, 0.020). In the fiberoptic bronchoscopy, alveolar lavage and brush biopsy, 75 patients did not have serious adverse reactions.After operation, there were 2 cases with blood in the sputum and 1 case with fever.The adverse reactions of above patients disappeared after 1-3 days.n Conclusion:XpertMTB/RIF, TB culture and TB-DNA have good clinical application value in detecting MTB in specimens of patients of tuberculosis, but in terms of rapid detection of tuberculosis and resistance to rifampicin, XpertMTB/RIF detection is more accurate.