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Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
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在结核性脑膜炎中GeneXpert MTB/RIF的诊断性能:一个多中心准确性研究
Chenyuan Wang1, Lina Davies Forsman2, Shanshan Wang1
1Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, China.
Diagnostic microbiology and infectious disease
|April 27, 2024
概括
基因Xpert MTB/RIF (Xpert) 测试对确定的结核性脑膜炎 (TBM) 的表现良好. 添加脑脊液 (CSF) 乳酸和葡萄糖水平显著提高了TBM诊断的准确性.
科学领域:
- 微生物学 微生物学
- 传染性疾病 传染性疾病
- 临床诊断 临床诊断 临床诊断
背景情况:
- 结核性脑膜炎 (TBM) 是一种严重的结核病形式,具有高死亡率和神经系统后果.
- 准确和快速诊断TBM仍然是一个重大挑战,特别是在资源有限的环境中.
研究的目的:
- 为了评估GeneXpert MTB/RIF (Xpert) 测定TBM的诊断性能.
- 确定额外的临床指标,以提高TBM的诊断准确性.
主要方法:
- 一项准确性研究招募了243名TBM和140名非TBM患者在中国 (2011-2019) 三个TB指定设施.
- 在脑脊液 (CSF) 中发现Mycobacterium tuberculosis (Mtb) 的微生物证据作为参考标准.
- 增强分类和回归树 (CART) 确定了额外的指标,ROC分析评估了诊断改进.
主要成果:
- 埃克斯珀特的诊断灵敏度为71.1%的确定的TBM和5.5%的可能/可能的TBM.
- 艾克斯珀特阳性与中枢神经液体体积增加和中枢神经液体黄色颜色相关.
- 将CSF乳酸和葡萄糖水平作为通过CART识别的额外指标,提高了对96.1% (确定的TBM) 和84.6% (可能/可能的TBM) 的敏感性.
结论:
- GeneXpert MTB/RIF测定为确定的TBM提供了令人满意的诊断性能.
- 结合Xpert与CSF乳酸和葡萄糖测量的联合使用,显著提高了TBM的诊断准确性,包括可能/可能的病例.
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