| Objective:At present,tuberculosis is still one of the most prevalent infectious diseases in the world and is extremely prone to death.Due to population density,environmental pollution,malnutrition and other reasons,mycobacterium tuberculosis infection is frequent in China and the incidence of tuberculosis is high.In clinical practice,patients with tuberculosis often have multiple clinical manifestations,slow process and complicated symptoms,which are prone to missed diagnosis or misdiagnosis anddelay the treatment time.Therefore,early diagnosis and timely treatment are very important to improve the quality of patientsafter recovery and reduce the mortality rate.Currently,the development of research on tuberculosis is slow,and few new diagnostic techniques have been developed.Nowadays,there are many laboratory methods for tuberculosis diagnosis,including etiological detection,immunological determination,molecular biological analysis,etc.Each method has its own advantages and disadvantages in detecting mycobacterium tuberculosis infection.In this study,the PCR-fluorescence probe method?Xpert MTB/RIF?,T-SPOT.TB and TB IgG antibody protein chip method?TB-Ab?applied in clinical laboratories in recent years were selected to analyze their diagnostic value for tuberculosis,respectively.464 patients were collected from January 2018 to January 2019 in Hebei Chest Hospital,296 of who were diagnosed with pulmonary tuberculosis,including171 males and 125 females,with an age of 40.9±20.0 years.49males and 36 females were from the 85 cases with extrapulmonary tuberculosis,with an age of 41.0±20.1.Tuberculosis diagnosis is based on the"People's Republic of China Health Industry Standard Tuberculosis Diagnosis WS 288-2017".During the same period,83 hospitalized non-tuberculosis patients were the control group,including 45 males and 38females,with an age of 41.0±19.6.Methods:1.Specimens?sputum,bronchoalveolar lavage fluid,pus,etc.?from the464 patients were collected and prepared for the Xpert MTB/RIF testing.2.5ml of heparin anticoagulated venous blood from patients were collected,thenequal Ficoll-PaqueTMPlus lymphocyte separation solution were added to centrifugally extract peripheral mononuclear cells.The cell was adjusted to the appropriate density with the culture solution,then were added into a 96-well reaction plate and incubated for 16-20 hours.After thatthe reaction plate was washed with PBS for 3 to 5 times,and incubated with the enzyme standard solution for 1 hour.The reaction plate was washed again 3 to5 times,and the coloring solution was added and incubated for 7minutes.After the termination of the reaction,the spots were counted under a microscope,and the results of the T-SPOT.TB assay were interpreted.3.Venous blood samples were collected from patients with 3ml separationgel coagulation tube,and serum was obtained by centrifugation.Take the test piece and add PBS to infiltrate the surface of the reaction film.Then the serum was injected and standed for 1 min.The PBS was injected again,after permeation,the colloidal gold labeled anti-human IgG was added.Finally,the PBS was added,and the TB-Ab test result was judged on the machine after the membrane was dried.Negative and positive controls were all used for the above three detection methods.4.Analysis was performed using SPSS for windows,version 22.0.The continuous variables was use variance analysis.Chi-square test was used to analyze the results of pairing comparison.The P<0.05was considered statistically significant.Results:1.296 patients with pulmonary tuberculosis were detected by Xpert MTB/RIF method.The results were positive in 191 cases and negative in 105cases.The sensitivity was 64.53%,the specificity was 93.98%,and the accuracy was 70.98%.Among 85 patients with extrapulmonary tuberculosis,46 positive cases and 39 negative cases were detected.The sensitivity,speci-ficity and accuracy were 54.12%,93.98%,and 73.81%,respectively.5 cases were positive and 78 cases were negativein the conrol goup.The test results of this method show thatthere were statistical differences?P<0.05?in pulmonary tuberculosis group vs control group and extrapulmonary tuberculosis group vs control group.The test results of pulmonary tuberculosis group vs extrapulmonary tuberculosis group has no statistical difference?P>0.05?.296 patients with pulmonary tuberculosis were detected by T-SPOT.TB method.The results were positive in 235 cases and negative in 61 cases.The sensitivity,specificity and accuracy were 79.39%,80.72%,79.68%,respectively.Among 85 patients with extrapulmonary tuberculosis,67 positive cases and 16 negative cases were detected.The sensitivity was 78.82%,the specificity was 80.72%,and the accuracy was 79.76%.16 cases were positive and 67 cases were negativein the conrol goup.The test results of this method show that there were statistical differences?P<0.05?in pulmonary tuberculosis group vs control group and extrapulmonary tuberculosis group vs control group.The test results of pulmonary tuberculosis group vs extrapulmonary tuberculosis group has no statistical difference?P>0.05?.296 patients with pulmonary tuberculosis were detected by TB-Ab method.The results were positive in 201 cases and negative in 22 cases.The sensitivity was 67.91%,the specificity was 73.49%,and the accuracy was69.13%.Among 85 patients with extrapulmonary tuberculosis,52 positive cases and 33 negative cases were detected.The sensitivity of detection was61.18%,the specificity was 73.49%,and the accuracy was 67.26%.22 cases were positive and 61 cases were negativein the conrol goup.The test results of this method show thatthere were statistical differences?P<0.05?in pulmonary tuberculosis group vs control group and extrapulmonary tuberculosis group vs control group.The test results of pulmonary tuberculosis group vs extrapulmonary tuberculosis group has no statistical difference?P>0.05?.2.In the tuberculosis group,the result of pairwise comparisonof three methods showed that there were significant differences in the resultswith Xpert MTB/RIF vs T-SPOT.TB&T-SPOT.TB vs TB-Ab?all P<0.05?.There was no statistical difference between Xpert MTB/RIF and TB-Ab?P>0.05?.In the control group,the result of pairwise comparisonof three methods showed that there were significant differences in the results with Xpert MTB/RIF vs T-SPOT.TB&Xpert MTB/RIF vs TB-Ab?all P<0.05?.The test results of T-SPOT.TB has no statistical difference with that of TB-Ab?P>0.05?.The comprehensive diagnostic index accuracy of the tuberculosis group was T-SPOT.TB>Xpert MTB/RIF>TB-Ab.Conclusion:1.For patients with pulmonary tuberculosis or extrapulmonary tuberculosis,Xpert MTB/RIF has the highest specificity,and T-SPOT.TB has the best sensitivity.2.The three methods have similarly sensitive in the diagnosis of tuberculosis and extrapulmonary tuberculosis.3.Considering the comprehensive diagnostic performance,T-SPOT.TB is superior to Xpert MTB/RIF and TB-Ab.T-SPOT.TB has good clinical application value. |
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