摘要
目的：采用EBUS-TBNA技术联合Xpert MTB/RIF技术对纵膈淋巴结结核进行诊断，对其临床应用价值进行探讨。方法：以138例疑似纵膈淋巴结结核患者为研究对象，所有患者均进行EBUS-TBNA检查，对获取的标本分别进行病理切片检查、Mtb-PCR 检测和Xpert检测，对不同穿刺部位淋巴结基本特征及细胞病理学进行统计分析，比较敏感度、特异度、阳性和阴性预测值，并根据Xpert检测结果对利福平耐药性进行分析。结果：本研究共对138例患者的256个淋巴结取样，对穿刺2R、4R、4L、7、10R、11R、11L组淋巴结阳性率分别为66.67%、84.62%、75.00%、75.49%、66.67%、88.00%及71.43%，总诊断阳性率为78.52%；三组的纵膈淋巴结结核检出率显示病理诊断组检出率为69.57%，EUBS-TBNA+Mtb—PCR检出率为58.70%，EUBS-TBNA+Xpert为70.29%；病理诊断组与EUBS-TBNA+Mtb—PCR比较有显著差异（P<0.05），病理诊断组与EUBS-TBNA+Xpert比较不具有显著性（P>0.05）；以病理诊断为标准，EUBS-TBNA+Mtb—PCR和EUBS-TBNA+Xpert的敏感度分别为72.92%和93.75%，特异度为73.81%和83.33%，阳性预测值为86.42%和92.78%，阴性预测值为54.39%和85.37%。且EUBS-TBNA+Mtb—PCR组与病理检查组一致性中等（Kappa值=0.425>0.4），EUBS-TBNA+Xpert与病理检查组一致性较好（Kappa值=0.776>0.61）；EUBS-TBNA+Xpert法与比例法药敏试验一致性较好（Kappa值=0.688>0.61）。结论：EBUS-TBNA联合Xpert MTB/RIF对纵膈淋巴结结核的诊断有较高的敏感度和特异度，具有重要临床价值。
关键词： EBUS-TBNA；Xpert MTB/RIF；纵膈淋巴结结核；诊断
Abstract
Objective: The EBUS-TBNA technology combined with Xpert MTB/RIF technology was used to diagnose mediastinal lymph node tuberculosis, and its clinical application value was discussed. Methods: Taking 138 patients with suspected mediastinal lymph node tuberculosis as the research object, all patients underwent EBUS-TBNA examination, and Pathological examination,Mtb-PCR detectionand Xpert detection were performed on the obtained specimens. In this study, the basic characteristics and cytopathology of lymph nodes at different puncture sites were statistically analyzed. The sensitivity, specificity, positive and negative predictive value of the two groups were compared, and the resistance of rifampicin was analyzed based on the Xpert test results. Results: In this study, a total of 256 lymph nodes were sampled from 138 patients. The positive rates of lymph nodes in the 2R, 4R, 4L, 7, 10R, 11R, and 11L groups were 66.67%, 84.62%, 75.00%, 75.49%, 66.67%, 88.00%and 71.43%.The detection rate of mediastinal lymph node tuberculosis in the three groups was 69.57%, 58.70%, and 70.29% in the pathologic diagnosis group, respectively. There were significant differences between the pathologic diagnosis group and EUBS-TbNA + MTB -- PCR (P<0.05), there was no significant difference between EUBS-TBNA+Xpert and the pathological diagnosis group (P>0.05).Based on the criteria of pathological diagnosis, the sensitivity, specificity, positive predictive value and negative predictive value of EUBS-TBNA+ MTB -- PCR and EUBS-TBNA+ Xpert were 72.92% and 93.75%, 73.81% and 83.33%, respectively.The consistency between EUBS-TBNA+ MTB -- PCR group and pathological examination group was moderate (Kappa value=0.425>0.4), EUBS-TBNA+ Xpert was in good agreement with pathological examination group (Kappa =0.776>0.61);The consistency of EUBS-TBNA+Xpert and proportional drug sensitivity test was good (Kappa=0.688>0.61). Conclusion : EBUS-TBNA combined with XPERT MTB/RIF has high sensitivity and specificity in the diagnosis of mediastinal lymph node tuberculosis, which has important clinical value.
Key words： EBUS-TBNA; Xpert MTB/RIF; mediastinal lymph node tuberculosis; diagnosis
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