| Objective: Tuberculosis of lymph node is one of the lymph node infectious diseases caused by Mycobacterium tuberculosis,and a common type of extra pulmonary tuberculosis.The onset of extra pulmonary tuberculosis is relatively more occult,and symptoms are not typical.Therefore,fast and accurate laboratory diagnosis and reasonable treatment plan are the key factors for the prognosis of patients.In recent years,the emergence of rifampicin resistant Mycobacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system(Gene Xpert? MTB/RIF)make it possible that detecting human Mycobacterium tuberculosis in 2 hours and determine whether the strain is belongs to rifampicin resistant strains at the same time.To evaluate the diagnostic value of Gene Xpert? MTB/RIF Gene in the diagnosis of lymph node tuberculosis by fine needle aspiration,we used this technique in detection of patients with clinically diagnosed lymphoid tuberculosis and non-lymphoid tuberculosis by fine needle aspiration.Methods:1 A total of 120 patients with lymphoid enlargement admitted to Hebei Chest Hospital were retrospectively selected from July 2014 to July 2016,and collected the case data.Among these patients,80 cases were included in the lymphoid tuberculosis group,including 37 cases were males and 43 cases were females,aged from 18 to 69 years old(medium age: 39.4 years old).Among them 40 cases(13 patients with malignant lymph node enlargement,21 patients with acute lymphadenitis,and 6 patients with other diseases)were included in the non-lymphoid tuberculosis group.All patients were diagnosed by bacteriology,pathology,molecular biology,imaging and other clinical diagnosis.Among these patients,98 cases were with superficial(cervical,clavicle,axillary and inguinal area,etc.)lymphoid enlargement,66 cases ofwhich were diagnosed with lymph node tuberculosis;22 cases were with mediastinal lymphoid enlargement,14 cases of which were diagnosed with lymphoid tuberculosis.And,56 patients were with pulmonary tuberculosis,and 6 patients were with diabetes mellitus.2 The selected patients underwent fine needle aspiration cytology(FNAC)detection with fine needle aspiration biopsy technique,modified LowensteinJenson medium culture and fine needle aspiration lotion Gene Xpert? MTB/RIF detection.And the sensitivity and specificity of the three methods were compared.We collected the clinical results and established the database.?2 test was performed to compare the differences between different groups.3 Strains which were positive in modified Lowenstein-Jenson medium culture were cultivated for rifampicin drug sensitive test(by promotional method),and compared with Gene Xpert? MTB/RIF method.Results:1 Gene Xpert? MTB/RIF,FNAC and Mycobacterium tuberculosis cultivation: Among 120 cases with lymph node enlargement,80 cases were diagnosed clinically with tuberculosis of lymph node and the other 40 cases were caused by other reasons.Regarding clinical diagnosis as the golden standard,the sensitivities and specificities of FNAC,cultivation and Gene Xpert? MTB/RIF detection were 85.0%(68/80)and 80.0%(32/40),38.8%(31/80)and 97.5%(39/40),91.3%(73/80)and 100.0%(40/40),respectively.We compared the sensitivity of Gene Xpert? MTB/RIF detection with those of FNAC and cultivation,and the difference had statistical significance(?2=5.63 and ?2=7.96;P<0.05 and P<0.01);the specificity of Gene Xpert?MTB/RIF(100.0%)was compared with that of FNAC(80.0%),and the difference had statistical significance(?2=8.74,P<0.01);the specificity of Gene Xpert? MTB/RIF(100.0%)was compared with that of cultivation(97.5%),and the difference had no statistical significance(?2=0.43,P>0.05).2 The results of Mycobacterium tuberculosis detection with different aspiration positions: in this trial there were a total of 98 cases with superficial lymph node and 22 cases with mediastinal lymph node.Regarding clinicaldiagnosis as the golden standard,66 patients had superficial tuberculosis of lymph node and 14 had mediastinal tuberculosis of lymph node.The sensitivities of superficial tuberculosis of lymph node and mediastinal tuberculosis of lymph node detected by FNAC,cultivation and Gene Xpert?MTB/RIF were 90.9%(60/66)and 64.3%(9/14);40.9%(27/66)and 28.6%(4/14);93.9%(62/66)and 78.6%(11/14).The sensitivities of FNAC,cultivation and Gene Xpert? MTB/RIF to superficial tuberculosis of lymph node and mediastinal tuberculosis of lymph node were different,and the differences had statistical significance(?2=5.72,4.52 and 4.17;all P<0.05).3 The results of Mycobacterium tuberculosis detection with different aspiration methods: the lymph node aspiration methods in the trial were divided into 2 types: under non-guidance(blind aspiration,etc.)and under guidance(ultrasonic,CT etc.).Meanwhile,26 patients with tuberculosis of lymph node received the aspiration under non-guidance and 54 patients with tuberculosis of lymph node received the aspiration under guidance and.The positive rates under guidance and non-guidance of FNAC,cultivation and Gene Xpert? MTB/RIF were 73.1%(19/26)and 92.6%(50/54);30.8%(8/26)and 42.6%(23/54);84.7%(23/26)and 92.6%(50/54),respectively.The positive rates of FNAC and cultivation with different aspiration methods were different,and the differences had statistical significance(?2=4.98 and 2.45,P<0.05).The positive rates of Gene Xpert? MTB/RIF with different aspiration methods,had no statistical significant difference(?2=0.27,P >0.05).4 Gene Xpert? MTB/RIF and the drug sensitivity results of proportional method: In the 120 samples with lymph node enlargement,31 samples with tuberculosis of lymph node were positive in modified L-J culture.Then its colony was taken,and the drug resistance of Mycobacterium tuberculosis to rifampicin was detected by proportional method.The results showed that 16 cases were resistant to rifampicin,which were consistent with the results of Gene Xpert? MTB/RIF.And the 16 samples were the same with the two different methods.There were 73 positive samples of mycobacteriumtuberculosis detected by Gene Xpert? MTB/RIF,and the rpo B gene mutation rate was 21.92%(16/73).Conclusion: In the diagnosis of tuberculosis of lymphoid,fine needle aspiration Gene Xpert? MTB/RIF detection can significantly improve the detection rate of lymphoid tuberculosis patients,providing a new way for rapid and accurate diagnosis of lymph node tuberculosis.At the same time,it can also screen for rifampicin-resistant patients with tuberculosis infection,thus providing a new basis early diagnosis and treatment. |
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