Clinical application of fluorescent quantitative PCR in detection of patients with extra-pulmonary tuberculosis

doi:10.3877/cma.j.issn.1674-1358.2018.03.010

Abstract

Abstract:

Objective

To evaluate the effect of GeneXpert Mycobacterium tuberculosis/Rifampin (GeneXpert MTB/RIF) in detection of Mycobacterium tuberculosis in pericardial and pleural effusion samples.

Methods

From January 2015 to June 2017, data of 286 suspected cases with tuberculosis were collected from The First people’s Hospital and Hanchuan People’s Hospital. There were 158 cases with pleural effusion and 128 cases with pericardial effusion, respectively. Each sample was examined by acid fast staining, smear microscopy, LJ Culture and GeneXpert MTB/RIF assay, respectively. Taking Mycobacterium LJ culture as the gold standard, the effect of GeneXpert MTB/RIF in detecting MTB was evaluated.

Results

Among the 286 effusion samples, 5 (17.8%) were MTB positive for LJ cultured, 43 (15%) were MTB positive determined by GeneXpert MTB/RIF, and 11 (3.8%) were MTB positive detected by acid-fast stain microscopy. The sensitivity, specificity, positive predictive value and negative predictive value of GeneXpert technology were 84.3%, 100%, 100% and 84.3%, respectively; while those of the acid fast stain method were 18.3%, 99.1%, 81.8% and 99.1%, respectively. The sensitivity of MTB in pericardial effusion was up to 90% detected by GeneXpert. GeneXpert MTB/RIF and acid-fast stain microscopy showed significant difference in the identification of Mycobacterium tuberculosis in two samples (χ² = 233.199, 33.715; all P < 0.001).

Conclusion

GeneXpert MTB/RIF technology has high sensitivity and specificity on detecting MTB in pleural effusion and pericardial effusion.

Key words: Tuberculous pleurisy, Tuberculous pericarditis, GeneXpert Mycobacterium tuberculosis/Rifampin, Extrapulmonary tuberculosis

Jiangqin Song, Jian Xiang, Hao Yang, Jin Zhou. Clinical application of fluorescent quantitative PCR in detection of patients with extra-pulmonary tuberculosis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(03): 251-255.

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References 20

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检测方法	胸腔积液（158例）	心包积液（128例）	合计（286例）
抗酸染色	8（5.06）	3（2.34）	11（3.85）
GeneXpert	30（18.99）	13（10.16）	43（15.04）
罗氏培养	33（20.89）	18（14.06）	51（17.83）

检测方法	胸腔积液（158例）	心包积液（128例）	合计（286例）
抗酸染色	8（5.06）	3（2.34）	11（3.85）
GeneXpert	30（18.99）	13（10.16）	43（15.04）
罗氏培养	33（20.89）	18（14.06）	51（17.83）

样本类型	GeneXpert	罗氏培养		合计
样本类型	GeneXpert	阳性	阴性	合计
胸腔积液	阳性	13	0	13
胸腔积液	阴性	5	110	115
	合计	18	110	128
心包积液	阳性	30	0	30
心包积液	阴性	3	125	128
	合计	33	125	158
两者合计	阳性	43	0	43
两者合计	阴性	8	235	243
	总计	51	235	286

样本类型	GeneXpert	罗氏培养		合计
样本类型	GeneXpert	阳性	阴性	合计
胸腔积液	阳性	13	0	13
胸腔积液	阴性	5	110	115
	合计	18	110	128
心包积液	阳性	30	0	30
心包积液	阴性	3	125	128
	合计	33	125	158
两者合计	阳性	43	0	43
两者合计	阴性	8	235	243
	总计	51	235	286

样本类型	χ²值	P值	灵敏度（%）	特异性（%）	阳性预测值（%）	阴性预测值（%）
胸腔积液	88.425	< 0.001	72.2	100.0	100.0	95.6
心包积液	140.270	< 0.001	90.0	100.0	100.0	97.6
两者合计	233.199	< 0.001	84.3	100.0	100.0	96.7

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