Xpert MTB/RIF Ultra improved the diagnosis of paucibacillary tuberculosis: A prospective cohort study
Xpert MTB/RIF Ultra improved the diagnosis of paucibacillary tuberculosis: A prospective cohort study
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Xpert MTB/RIF Ultra 改善了少杆菌结核病的诊断：一项前瞻性队列研究
DOI：
10.1016/j.jinf.2019.02.010
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发表时间：
2019-04-01
影响因子：
28.2
通讯作者：
Huang, Hairong
中科院分区：
文献类型：
--
作者：
Wang, Guirong;Wang, Shuqi;Huang, Hairong
目的：比较Xpert MTB/RIF Ultra(Xpert Ultra)和Xpert MTB/RIF(Xpert)对少菌型肺结核的诊断价值。方法：收集北京胸科医院(北京中国)疑似肺结核患者的痰、胸液和脑脊液，进行涂片、Xpert和培养。Xpert Ultra使用储存在零下80摄氏度的标本进行检测，所有回收的菌株都进行了药敏试验(DST)。以综合参考标准(CRS)为金标准，评价Xpert Ultra和Xpert的性能，包括临床、实验室、组织病理学、放射学和随访。对涂片阴性肺结核(70.89%vs57.88%，P=0.001)、结核性胸膜炎108例(61.11%vs34.26%，P<；0.001)和结核性脑膜炎43例(44.19%vs18.60%，P=0.011)，Xpert Ultra的诊断敏感性高于Xpert。合并Xpert Ultra结果后，确诊肺结核、结核性胸膜炎和结核性脑膜炎的比例分别由67.12%上升到78.77%、61.11%上升到69.44%和23.26%上升到51.16%。Xpert Ultra和Xpert的特异度分别为96.75%(238/246)和98.37%(242/246)。Xpert Ultra和Xpert在检测利福平耐药性方面表现相似。结论：与Xpert相比，Xpert Ultra具有更高的敏感性，但特异性相对较低。Xpert超声检查可提高涂片阴性肺结核、结核性胸膜炎和结核性脑膜炎的确诊率。(C)2019年英国感染协会。爱思唯尔有限公司出版。保留所有权利。
Objectives: We assessed the diagnostic performance of Xpert MTB/RIF Ultra (Xpert Ultra) in comparison to Xpert MTB/RIF (Xpert) for the detection of paucibacillary tuberculosis (TB).Methods: Smear-negative sputum, pleural fluid and cerebrospinal fluid (CSF) were collected from TB suspects at Beijing Chest Hospital (Beijing, China) and were examined using smear, Xpert and culture. Xpert Ultra was tested using specimens stored at -80 degrees C. Drug susceptibility testing (DST) was conducted for all of the isolates recovered. The performances of Xpert Ultra and Xpert were evaluated using composite reference standard (CRS) as gold standard, which included clinical, laboratory, histopathological, radiological and follow-up features.Results: Totally 689 cases were included. The direct head-to-head diagnostic performance comparison showed higher sensitivity of Xpert Ultra in contrast with Xpert among 292 smear-negative pulmonary TB (PTB) (70.89% vs 57.88%, P = 0.001), 108 tuberculous pleurisy (61.11% vs 34.26%, P < 0.001), and 43 tuberculous meningitis (44.19% vs 18.60%, P = 0.011). The percentage of definite PTB, tuberculous pleurisy and tuberculous meningitis increased from 67.12% to 78.77%, 61.11% to 69.44% and 23.26% to 51.16%, respectively after integrating Xpert Ultra outcomes. The specificity of Xpert Ultra and Xpert was 96.75% (238/246) and 98.37% (242/246), respectively. Xpert Ultra and Xpert performed similarly in detecting rifampicin resistance.Conclusion: Xpert Ultra has higher sensitivity but relatively reduced specificity compared with Xpert in diagnosis of paucibacillary TB. Performing Xpert Ultra would improve the definite diagnosis of smear-negative pulmonary tuberculosis, tuberculous pleurisy and tuberculous meningitis. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.