上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2021 , Vol. 41 >Issue 10: 1318 - 1322

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.10.008

论著 · 临床研究

Xpert MTB/RIF检测对淋巴结结核的诊断价值

  • 柯荟 ,
  • 桂徐蔚 ,
  • 顾瑾
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  • 同济大学附属上海市肺科医院结核科，上海 200433
柯 荟（1988—），女，主治医师，硕士；电子信箱：kdx5566@sina.com。
顾 瑾，电子信箱：gujin51250@163.com。

网络出版日期: 2021-09-23

基金资助

上海市感染性疾病（结核病学）临床医学研究中心项目(19MC1910800)

收起

Diagnostic value of Xpert MTB/RIF in lymph node tuberculosis

  • Hui KE ,
  • Xu-wei GUI ,
  • Jin GU
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  • Department of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
GU Jin, E-mail: gujin51250@163.com.

Online published: 2021-09-23

Supported by

Shanghai Clinical Research Center for infectious disease （tuberculosis）(19MC1910800)

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摘要

目的·分析联合利福平耐药实时荧光定量核酸扩增技术（rifampicin resistant Mycobacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system，Xpert MTB/RIF）检测对于提高淋巴结结核诊断率的意义。方法·回顾性分析2016年1月至2018年12月在上海市肺科医院初次诊断为颈淋巴结结核并接受淋巴结穿刺的351例患者的临床资料，包括淋巴结穿刺物的结核分枝杆菌涂片、结核分枝杆菌培养、结核分枝杆菌DNA检测、病理学检测及Xpert MTB/RIF检测结果；分析不同检测方法的阳性率及结核分枝杆菌涂片、结核分支杆菌培养、结核分支杆菌DNA检测、病理学检测分别联合Xpert MTB/RIF检测的阳性率。结果·共纳入145 例确诊淋巴结结核的患者。其中，结核分枝杆菌涂片阳性患者39 例，结核分枝杆菌DNA阳性患者74 例，Xpert MTB/RIF检出患者111例，结核分枝杆菌培养阳性患者51 例，病理检测阳性患者87 例。Xpert MTB/RIF检出8 例利福平耐药患者，其中6 例患者结核分枝杆菌培养阴性，2例患者结核分枝杆菌培养阳性并提示利福平耐药。结核分枝杆菌DNA联合Xpert MTB/RIF检测阳性率最高（91.0%），显著高于结核分枝杆菌涂片联合Xpert MTB/RIF检测（80.7 %），差异有统计学意义（P=0.017）；同时也高于结核分枝杆菌培养联合Xpert MTB/RIF检测（88.3 %）及病理检测联合Xpert MTB/RIF检测（90.3%），但差异均无统计学意义（均P>0.05）。结论·联合 Xpert MTB/RIF检测可提高淋巴结结核早期诊断率。

关键词： 利福平耐药实时荧光定量核酸扩增技术; 淋巴结结核; 诊断; 耐药

本文引用格式

柯荟 , 桂徐蔚 , 顾瑾 . Xpert MTB/RIF检测对淋巴结结核的诊断价值[J]. 上海交通大学学报（医学版）, 2021 , 41(10) : 1318 -1322 . DOI: 10.3969/j.issn.1674-8115.2021.10.008

Abstract

Objective

·To analyze the significance of the combination of rifampicin-resistant Mycobacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system (Xpert MTB/RIF) detection in improving the diagnostic rate of lymph node tuberculosis.

Methods

·Retrospective analysis was performed on the clinical data of 351 patients who were initially diagnosed with cervical lymph node tuberculosis and received lymph node puncture in Shanghai Pulmonary Hospital from January 2016 to December 2018. The lymph node puncture materials were sent for tuberculosis smear, tuberculosis culture,tuberculosis DNA test, pathology test and Xpert MTB/RIF test. The positive rates of different detection methods and tuberculosis smear, tuberculosis culture, tuberculosis DNA test and pathological test combined with Xpert MTB/RIF test were analyzed.

Results

·A total of 145 patients with confirmed lymph node tuberculosis were included. Among them, 39 patients were tuberculosis smear positive, 74 patients were tuberculosis DNA positive, 111 patients were Xpert MTB/RIF positive, 51 patients were tuberculosis culture positive, and 87 patients were pathologically positive. Xpert MTB/RIF detected 8 patients with rifampicin drug resistance, of which 6 patients were negative in tuberculosis culture, and 2 patients were rifampicin drug resistant in tuberculosis culture. The positive rate of tuberculosis DNA combined with Xpert MTB/RIF was the highest (91.0%), which was significantly higher than that of tuberculosis smear combined with Xpert MTB/RIF (80.7%), and the difference was statistically significant (P=0.017). It was also higher than that of tuberculosis culture combined with Xpert MTB/RIF test (88.3%) and pathology combined with Xpert MTB/RIF test (90.3%), but there was no statistical significance (all P>0.05).

Conclusion

·The combination of Xpert MTB/RIF could improve the early diagnosis rate of lymph node tuberculosis.

Key words： rifampicin-resistant Mycobacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system (Xpert MTB/RIF); lymph node tuberculosis; diagnosis; drug resistance

参考文献

1 Drobniewski FA, Caws M, Gibson A, et al. Modern laboratory diagnosis of tuberculosis[J]. Lancet Infect Dis, 2003, 3(3): 141-147.
2 Mohapatra PR, Janmeja AK. Tuberculous lymphadenitis[J]. J Assoc Physicians India, 2009, 57: 585-590.
3 Gautam H, Agrawal SK, Verma SK,et al. Cervical tuberculous lymphadenitis: clinical profile and diagnostic modalities[J]. Int J Mycobacteriol, 2018, 7(3): 212-216.
4 Muluye D, Biadgo B, Woldegerima E, et al. Prevalence of tuberculous lymphadenitis in Gondar University Hospital, Northwest Ethiopia[J]. BMC Public Health, 2013, 13: 435.
5 Sandu I, Mihai D, Corneci C, et al. Cervical lymph nodes, a diagnostic dilemma[J]. Acta Endocrinol (Buchar), 2020, 16(1): 112-113.
6 MacNeil A, Glaziou P, Sismanidis C, et al. Global Epidemiology of Tuberculosis and Progress Toward Meeting Global Targets-Worldwide, 2018[J]. Morb Mortal Wkly Rep, 2020, 69(11): 281-285.
7 Horne DJ, Kohli M, Zifodya JS, et al. Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults[J]. Cochrane Database Syst Rev, 2019, 6(6): CD009593.
8 World Health Organization. Xpert MTB/RIF Implementation Manual: Technical and Operational 'How-To'; Practical Considerations[R]. Geneva: World Health Organization, 2014.
9 高荣樑, 陈晋. GeneXpert Mtb/RIF检测技术在临床耐药结核病诊断中的应用价值[J]. 同济大学学报(医学版), 2017, 38(2): 106-109.
10 中国防痨协会基础专业委员会. 结核病诊断实验室检验规程[M]. 北京: 中国教育文化出版社, 2006: 54-62.
11 Floyd K, Glaziou P, Houben R, et al. Global tuberculosis targets and milestones set for 2016-2035: definition and rationale[J]. Int J Tuberc Lung Dis, 2018, 22(7): 723-730.
12 GBD Tuberculosis Collaborators. Global, regional, and national burden of tuberculosis, 1990-2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study[J]. Lancet Infect Dis, 2018, 18(12): 1329-1349.
13 Mokrousov I, Otten T, Vyshnevskiy B, et al. Allele-specific rpoB PCR assays for detection of rifampin-resistant Mycobacteriumtuberculosis in sputum smears[J]. Antimicrob Agents Chemother, 2003, 47(7): 2231-2235.
14 Moualed D, Robinson M, Qureishi A, et al. Cervical tuberculous lymphadenitis: diagnosis and demographics, a five-year case series in the UK[J]. Ann R Coll Surg Engl, 2018, 100(5): 392-396.
15 Denkinger CM, Schumacher SG, Boehme CC, et al. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis[J]. Eur Respir J, 2014, 44(2): 435-446.
16 Penz E, Boffa J, Roberts DJ,et al. Diagnostic accuracy of the Xpert?MTB/RIF assay for extra-pulmonary tuberculosis: a meta-analysis[J]. Int J Tuberc Lung Dis,2015, 19(3): 278-284.
17 徐美丽. 细针穿刺洗脱液Gene Xpert MTB/RIF检测技术对淋巴结结核诊断价值研究[D]. 石家庄: 河北医科大学, 2016.
18 Tadesse M, Abebe G, Abdissa K, et al. GeneXpert MTB/RIF assay for the diagnosis of tuberculous lymphadenitis on concentrated fine needle aspirates in high tuberculosis burden settings[J]. PLoS One, 2015, 10(9): e0137471.
19 Detjen AK, DiNardo AR, Leyden J, et al. Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis[J]. Lancet Respir Med, 2015, 3(6): 451-461.
20 Asimacopoulos EP, Berry M, Garfield B, et al. The diagnostic efficacy of fine-needle aspiration using cytology and culture in tuberculous lymphadenitis[J]. Int J Tuberc Lung Dis, 2010, 14(1): 93-98.
21 Buchko GW, Echols N, Flynn EM, et al. Structural and biophysical characterization of the Mycobacterium tuberculosis protein Rv0577, a protein associated with neutral red staining of virulent tuberculosis strains and homologue of the streptomyces coelicolor protein KbpA[J]. Biochemistry, 2017, 56(30): 4015-4027.
22 李自慧, 吕翎娜, 杜博平,等. 结核分枝杆菌IS6110和IS1081微滴数字PCR检测体系的建立和应用[J]. 北京医学, 2018, 40(04): 314-317.
23 Lee J, Choi SM, Lee CH, et al. The additional role of Xpert MTB/RIF in the diagnosis of intrathoracic tuberculous lymphadenitis[J]. J Infect Chemother, 2017, 23(6): 381-384.
24 Li HH, He ZJ, Liang JQ, et al. Evaluation of Xpert MTB/RIF for the diagnosis of lymphatic tuberculosis[J]. Biomed Res Int, 2020, 2020: 1968487.
25 Singh S, Singh A, Prajapati S, et al. Xpert MTB/RIF assay can be used on archived gastric aspirate and induced sputum samples for sensitive diagnosis of paediatric tuberculosis[J]. BMC Microbiol, 2015, 15: 191.
26 Moussa H, Bayoumi FS, Ali AM. Evaluation of GeneXpert MTB/RIF assay for direct diagnosis of pulmonary tuberculosis[J]. Saudi Med J, 2016, 37(10): 1076-1081.
27 中华医学会结核病学分会临床检验专业委员会.结核病病原学分子诊断专家共识[J]. 中华结核和呼吸杂志, 2018, 41(9): 688-695.
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