【摘要】 目的 探讨结核分枝杆菌及利福平耐药基因检测（GeneXpert MTB/RIF，简称GeneXpert）技术联合结核感染T细胞检测（TB-IGRA）及结核抗体（TB-Ab）检测技术在基层实验室中对初治涂阴肺结核患者诊断的临床诊断价值。方法 回顾性分析2014—2021年间北京市朝阳区疾病预防控制中心结核病门诊部初诊患者资料，筛选出初诊时痰涂片结果阴性，同时送检固体罗氏培养、GeneXpert TB-IGRA及TB-Ab检测的疑似肺结核患者。结果 经临床诊断涂阴肺结核患者1 174例，非肺结核患者1 054例，2组患者性别及年龄差异均无统计学意义。2组人群之间4种检测方法阳性率的比较，TB-IGRA检测阳性率均最高，分别为21.55%(253/1 174)和14.99%(58/1 054)，差异均具有统计学意义。以固体培养为金标准，Gene Xpert方法准确性和一致性均最高（92.86%,Kappa=0.675）,3种方法联合检测的灵敏度最高（80.45%），曲线下面积（AUC）仅次于Gene Xpert (0.923)。以临床诊断为金标准，固体培养法AUC最高（0.874）,4种方法联合检测的灵敏度最高（26.24%）。结论 TB-IGRA检测方法可以用于涂阴肺结核的快速诊断，多种方法联合检测可以有效提高涂阴肺结核检测的灵敏度。更多还原

【Abstract】 Objective To investigate the clinical diagnostic value of GeneXpert MTB/RIF technology combined with peripheral blood TB infection T cell assay(TB-IGRA) and TB antibody assay(TB-AB) in the diagnosis of patients with initial treatment of smear-negative tuberculosis in primary laboratory. Methods The data of newly diagnosed patients with the tuberculosis outpatient department of Chaoyang District Center for Disease Control and Prevention of Beijing from 2014 to 2021 were retrospectively analyzed, and the suspected tuberculosis patients with negative sputum smear results at the initial diagnosis were screened for solid Roche culture, GeneXpert MTB/RIF detection, peripheral blood TB infection T cell detection and TB-AB detection.Results There were 1 174 patients with pulmonary tuberculosis and 1 054 patients without pulmonary tuberculosis. No significant difference was found in gender and age between the two groups. In comparison of the positive rates of the four detection methods between the two groups, the positive rates of TB-IGRA were the highest, 21.55%(253/1 174) and 14.99%(158/1 054), respectively, and the differences were statistically significant.With solid culture as the gold standard, GeneXpert MTB/RIF detection method had the highest accuracy and consistency(92.86%, Kappa=0.675), and the combined detection sensitivity of the three methods was the highest(80.45%), and the area under the curve(AUC) was second only to GeneXpert MTB/RIF(0.923). Taking clinical diagnosis as the gold standard, the AUC of solid culture method were the highest(0.874), and the sensitivity of the combined detection of the four methods was the highest(26.24%). Conclusion TB-IGRA test can be used for smeare-negative tuberculosis′ s rapid diagnosis. The combined detection of multiple methods can effectively improve the sensitivity of the detection of smear-negative tuberculosis.更多还原