结核分枝杆菌及耐药基因快速检测对喉结核的诊断价值

The diagnostic value of rapid detection of Mycobacterium tuberculosis and drug resistance genes in laryngeal tuberculosis

摘要:

目的 评价结核分枝杆菌及其耐药基因快速检测(TB-Gene Xpert MTB/RIF)在喉结核的诊断及耐药性检测中的价值。方法 回顾性分析2018年1月—2024年6月在武汉大学人民医院接受初诊的94例疑似喉结核患者的临床资料。所有患者均进行胸部CT检查、血液结核感染T细胞检测(T-spot)、痰液涂片抗酸染色以及电子喉镜下病变组织采集。对采集的病变组织样本进行TB-Gene Xpert MTB/RIF检测、病理学检查及结核分枝杆菌培养。以临床综合诊断结果确诊的喉结核作为标准，对比分析各检测方法在喉结核诊断中的效能。结果 本研究共纳入94例疑似喉结核患者，最终确诊喉结核59例，非喉结核35例。以确诊的59例喉结核患者为参照，胸部CT、T-spot、痰涂片、组织分枝杆菌培养、病理学检测及TB-Gene Xpert MTB/RIF的敏感度分别为59.3%(35/59)、67.8%(40/59)、25.4%(15/59)、35.6%(21/59)、79.7%(47/59)和100%(59/59)；其特异度分别为42.9%(15/35)、51.4%(18/35)、91.4%(32/35)、100%(35/35)、85.7%(30/35)和94.3%(33/35)。TB-Gene Xpert MTB/RIF检测的敏感度达到100%，显著高于其他检测方法(P＜0.01)；其特异度为94.3%(33/35)，显著高于胸部CT和T-spot(P＜0.01)，但与痰涂片、组织分枝杆菌培养及病理学检测的特异度比较差异无统计学意义(P>0.05)。此外，TB-Gene Xpert MTB/RIF技术成功检测出2例利福平耐药菌株中rpoB基因突变，耐药检测敏感度为100%。结论 TB-Gene Xpert MTB/RIF技术在喉结核诊断中具有快速、简便、高敏感度和高特异度等优势，可有效识别利福平耐药患者，适用于喉结核的早期诊断，有助于降低该病漏诊和误诊风险。

Abstract:

Objective To evaluate the value of rapid detection of Mycobacterium tuberculosis (TB) and drug-resistant gene (TB-Gene Xpert MTB/RIF) for laryngeal TB. Methods A retrospective analysis was conducted on the clinical data of 94 patients with suspected laryngeal TB who were initially diagnosed at Renmin Hospital of Wuhan University from January 2018 to June 2024. All patients underwent chest computerized tomography (CT) examination, blood TB infection T-cell detection (T-spot), and sputum smear acid-fast staining and lesion tissue collection under electronic laryngoscopy. The collected lesion tissue samples were subjected to TB-Gene Xpert MTB/RIF assay, pathological examination, and Mycobacterium TB culture. Taking the clinical comprehensive diagnosis results of laryngeal TB patients as the gold standard, the efficacy of each detection method in the diagnosis of laryngeal TB was compared and analyzed. Results A total of 94 patients suspected of having laryngeal TB were included in this study, with 59 confirmed cases of laryngeal TB and 35 non-laryngeal TB cases. Taking the 59 confirmed cases of laryngeal TB as the reference, the sensitivities of chest CT, T-spot, sputum smear, tissue Mycobacterium culture, pathological examination, and TB-Gene Xpert MTB/RIF were 59.3% (35/59), 67.8% (40/59), 25.4% (15/59), 35.6% (21/59), 79.7% (47/59), and 100% (59/59), respectively; their specificities were 42.9% (15/35), 51.4% (18/35), 91.4% (32/35), 100% (35/35), 85.7% (30/35), and 94.3% (33/35), respectively. The sensitivity of TB-Gene Xpert MTB/RIF assay reached 100%, which was significantly higher than those of other detection methods (P<0.01). Its specificity was 94.3% (33/35), slightly lower than that of tissue Mycobacterial culture (100%) and pathological examination (85.7%), but significantly higher than that of chest CT and T-spot assay(P<0.01). Furthermore, the TB-Gene Xpert MTB/RIF successfully detected rpoB gene mutations in 2 cases of rifampicin-resistant bacterial strains, and the sensitivity of the drug resistance test was 100%. Conclusions With advantages of rapidity, simplicity, high sensitivity and high specificity in the diagnosis of laryngeal TB, the TB-Gene Xpert MTB/RIF assay can effectively identify patients with rifampicin resistance and is suitable for the early diagnosis of laryngeal TB, helping to reduce the risks of missed diagnosis and misdiagnosis of this disease.