申振宇,郝跃鹏,冯建纯,贾涤静,张云婷

• 1:河北省胸科医院医务处
• 2:河北省胸科医院感染性疾病实验诊断中心

摘要(Abstract)：

目的 分析比较结核分枝杆菌复合群核酸检测（TB-DNA）与GeneXpert MTB/RIF（简称“Xpert”）在肺外结核（EPTB）诊断中的应用价值及不同临床特征下诊断效能。方法 收集2023年6月-2025年6月河北省胸科医院收治的155例疑似EPTB患者。以敏感度、特异度、阳性预测值、阴性预测值评估诊断价值；Kappa检验比较两种方法检测结果与BD BACTEC MGIT 960液体培养系统（MGIT 960培养）结果的一致性；受试者工作特征（ROC）曲线评估诊断效能；Delong检验比较曲线下面积（AUC）。结果 Xpert在淋巴结、胸膜、骨关节、脑膜部位的检出率高于TB-DNA，在腹膜部位检出率低于TB-DNA，在淋巴结穿刺液、浆膜腔积液的检出率高于TB-DNA，在组织的检出率低于TB-DNA，脓液及其他样本中二者检出率相近。TB-DNA和Xpert一致性Kappa值为0.329。Xpert的敏感度、阴性预测值最高；联合检测的特异度、阳性预测值、与MGIT 960培养一致性及AUC最高。Xpert诊断不同临床特征患者的AUC均大于TB-DNA，两种方法及联合检测均对淋巴结穿刺液标本诊断效能最高（AUC分别为0.812、0.826、0.873）。TB-DNA、Xpert与联合检测的AUC差异均有统计学意义（Z=4.067、3.357,P<0.05）。结论 Xpert对淋巴结结核、结核性脑膜炎的检出率更高；TB-DNA检测结核性腹膜炎更有优势。联合检测可提升诊断特异度与整体诊断效能，临床应根据发病部位和标本类型个体化选用检测方法。

关键词(KeyWords)： 肺外结核;结核分枝杆菌复合群核酸检测;GeneXpert MTB/RIF;BD BACTEC MGIT 960液体培养;诊断效能;联合检测

Abstract:

Keywords:

基金项目(Foundation): 河北省医学科学研究课题计划资助（20242027）

作者(Author): 申振宇,郝跃鹏,冯建纯,贾涤静,张云婷

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