Application of bronchoscopy combined with GeneXpert MTB/RIF or MALDI-TOF MS detection technology insputum etiology negative pulmonary tuberculosis patients
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维普
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目的 探讨支气管镜联合实时荧光定量PCR检测技术(GeneXpert MTB/RIF,Xpert)、基质辅助激光解吸电离飞行时间质谱检测技术(matrix-assisted laser desorption ionization-time of flight mass spectrometry,MALDI-TOF MS)在痰病原学阴性肺结核患者中的应用.方法 选择2021年8月1日至2023年7月31日芜湖市第三人民医院收治的260例痰病原学阴性疑似肺结核患者作为研究对象,取其肺泡灌洗液(bronchoalveolar lavage fluid,BALF)进行结核分枝杆菌固体罗氏培养(Lowenstein-Jenson,L-J)、Xpert、MALDI-TOF MS法检测,分析不同检测方法的诊断效能.结果 260例患者BALF使用L-J、Xpert及MALDI-TOF MS法检测,诊断肺结核的灵敏度分别为31.49％、69.38％、82.69％;Xpert与MALDI-TOF MS法灵敏度均高于L-J法(P均＜0.05),前2种方法灵敏度比较差异无统计学意义(P=0.061).其中,34例患者BALF同时进行了 L-J法、Xpert 法、MALDI-TOF MS 法检测,灵敏度分别为 29.03％、64.52％、80.64％;Xpert 与 MALDI-TOF MS 法灵敏度高于L-J法(P均＜0.05),前2种方法灵敏度比较差异无统计学意义(P=0.155);3种检测方法在利福平耐药阳性检出率方面,差异无统计学意义(P=0.817).结论 痰病原学阴性肺结核患者采用支气管镜联合Xpert、MALDI-TOFMS检测技术,具有良好的灵敏度和特异度,以及较好的临床应用前景.
Objective To investigate the application of bronchoscopy combined with real-time fluorescence quantitative PCR detection technology(GeneXpert MTB/RIF,Xpert)or matrix-assisted laser desorption ionization-time of flight mass spectrometry(MALDI-TOF MS)detection technology in sputum etiology negative pulmonary tuberculosis patients.Methods This study included 260 patients with suspected sputum etiology negative pulmonary tuberculosis who were treated at the Third People's Hospital of Wuhu from August 1,2021,to July 31,2023.Bronchoalveolar lavage fluid(BALF)was collected from these patients for testing using solid Lowenstein-Jensen culture(L-J),Xpert,and MALDI-TOF MS methods to evaluate the diagnostic efficacy of each technique.Results The sensitivity for diagnosing pulmonary tuberculosis in 260 patients were tested with L-J,Xpert,and MALDI-TOF MS was 31.49％,69.38％,and 82.69％,respectively.The sensitivities of Xpert and MALDI-TOF MS were significantly higher than that of L-J method(P＜0.05),with no significant difference between Xpert and MALDI-TOF MS(P=0.061).Among these,34 patients underwent simultaneous testing with L-J,Xpert,and MALDI-TOF MS,simultaneously.Upon reanalysis,the sensitivities were 29.03％,64.52％,and 80.64％,respectively.The sensitivities of Xpert and MALDI-TOF MS were higher than that of L-J method(P＜0.05),with no significant difference between the former two methods(P=0.155).There was no significant difference in the positive detection rate of rifampicin resistance among the three methods(P=0.817).Conclusions Bronchoscopy combined with Xpert and MALDI-TOFMS demonstrates high sensitivity and specificity in sputum etiology negative pulmonary tuberculosis patients,with promising clinical application prospects.
维普
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