Xpert MTB/RIF在涂阳患者中对NTM肺病的诊断价值及NTM菌种分布特征分析

刘文彬; 唐磊明; 王敏; 蔡成松; 潘峰

doi:10.16766/j.cnki.issn.1674-4152.004378

Xpert MTB/RIF在涂阳患者中对NTM肺病的诊断价值及NTM菌种分布特征分析

doi: 10.16766/j.cnki.issn.1674-4152.004378

杭州师范大学附属医院检验科，浙江杭州 310015

基金项目:

浙江省医药卫生科技计划项目 2021KY888

详细信息

通讯作者:
潘峰，E-mail: 2359506302@qq.com

中图分类号: R446.5 R378.91
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出版历程
- 收稿日期: 2025-05-24
- 网络出版日期: 2026-04-11

The diagnostic value of Xpert MTB/RIF for NTM pulmonary disease in smear-positive patients and analysis of the species distribution characteristics of NTM

Department of Laboratory Medicine, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的评估Xpert MTB/RIF在涂阳患者中对非结核分枝杆菌(NTM)肺病的诊断价值以及分析NTM的菌种分布，以提高临床对涂阳NTM肺病患者的早期诊断能力。方法回顾性选取2020年4月—2024年9月杭州师范大学附属医院收治的122例住院患者(NTM肺病73例、肺结核49例)为研究对象，以涂阳患者为分析亚组，通过Kappa分析验证Xpert与基质辅助激光解析电离飞行时间质谱(MALDI-TOF MS)对NTM肺病和肺结核的鉴别诊断一致性，同时分析NTM的菌种分布特征。结果 Xpert在涂阳NTM肺病、涂阴NTM肺病、涂阳肺结核和涂阴肺结核患者中阳性率分别为1.92%(1/52)、0%(0/21)、100.00%(38/38)、72.73%(8/11)，1例脓肿分枝杆菌脓肿亚种被Xpert误判为结核分枝杆菌(MTB)。73例NTM肺病患者中单一菌株感染79.45%(58/73)，2种及以上NTM菌株混合感染20.55%(15/73)，检测出的89株NTM菌型中较常见的分别为胞内分枝杆菌62.92%(56/89)和脓肿分枝杆菌17.98%(16/89)。Xpert与MALDI-TOF MS检测在涂阳患者中对NTM肺病和肺结核鉴别诊断的一致性极好(Kappa=0.938，P < 0.001)。结论胞内分枝杆菌是NTM肺病患者中最常见的菌种类型，其次为脓肿分枝杆菌。Xpert在涂阳患者中能有效区分NTM肺病与肺结核，对涂阳NTM肺病的诊断具有显著的临床价值。
- Xpert /
- 非结核分枝杆菌 /
- 结核分枝杆菌复合群 /
- MALDI-TOF MS
Abstract: Objective To evaluate the diagnostic value of Xpert MTB/RIF for nontuberculous mycobacterial (NTM) pulmonary disease among smear-positive patients and analyze the species distribution of NTM, thereby enhancing the clinical early diagnostic capability for such patients. Methods A total of 122 inpatients admitted to the Affiliated Hospital of Hangzhou Normal University from April 2020 to September 2024 were retrospectively selected as research subjects, including 73 cases of NTM lung disease and 49 cases of pulmonary tuberculosis. With smear-positive patients as the analysis subgroup, Kappa analysis was used to verify the consistency of Xpert and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in the differential diagnosis of NTM lung disease and pulmonary tuberculosis, and the species distribution characteristics of NTM were analyzed simultaneously. Results The positivity rates of Xpert MTB/RIF were 1.92% (1/52) in smear-positive NTM pulmonary disease, 0% (0/21) in smear-negative NTM pulmonary disease, 100.00% (38/38) in smear-positive pulmonary tuberculosis, and 72.73% (8/11) in smear-negative pulmonary tuberculosis. One case of Mycobacterium abscessus subsp. abscessus was misclassified as Mycobacterium tuberculosis by Xpert MTB/RIF. Among the 73 NTM pulmonary disease cases, single-strain infection accounted for 79.45% (58/73), and mixed infections with two or more NTM strains accounted for 20.55% (15/73). Among the 89 NTM strains detected by MALDI-TOF MS, the more common species were Mycobacterium intracellulare (62.92%, 56/89) and Mycobacterium abscessus (17.98%, 16/89). Xpert MTB/RIF and MALDI-TOF MS demonstrated excellent concordance in distinguishing NTM pulmonary disease from pulmonary tuberculosis among smear-positive patients (Kappa=0.938, P < 0.001). Conclusion Mycobacterium intracellulare was the most common NTM species in patients with NTM pulmonary disease, followed by Mycobacterium abscessus. Xpert MTB/RIF can effectively differentiate NTM pulmonary disease from pulmonary tuberculosis in smear-positive patients and exhibits significant clinical value for the diagnosis of smear-positive NTM pulmonary disease.
- Xpert /
- Nontuberculous mycobacteria /
- Mycobacterium tuberculosis complex /
- MALDI-TOF MS

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表 1 MALDI-TOF MS对89株NTM菌株的菌种鉴定结果及检出率

Table 1. The species identification results and detection rate of 89 NTM bacterial strains by MALDI-TOF MS

菌种类型	菌株数	检出率(%)
M.intracellulare	56	62.92
M.abscessus	16	17.98
M.abscessus subsp.abscessus	12	13.48
M.abscessus subsp.bolletii	2	2.25
M.abscessus subsp.massiliense	2	2.25
M.avium	4	4.49
M.kansasii	4	4.49
M.nonchromogenicum	2	2.25
M.triviale	2	2.25
M.xenopi	1	1.12
M.chelonae	1	1.12
M.simiae	1	1.12
M.gordonae	1	1.12
M.immunogenum	1	1.12
注：M.abscessus包括M.abscessus subsp.abscessus、M.abscessus subsp.bolletii和M.abscessus subsp.massiliense三种亚型。

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表 2 MALDI-TOF MS对73例NTM肺病患者的菌种鉴定结果

Table 2. The bacterial species identification results of 73 patients with NTM lung disease by MALDI-TOF MS

菌种类型	患者例数	检出率(%)
单一菌株感染	58	79.45
M.intracellulare	45	61.64
M.abscessus subsp.abscessus	4	5.48
M.kansasii	3	4.11
M.abscessus subsp.massiliense	2	2.74
M.triviale	2	2.74
M.xenopi	1	1.37
M.nonchromogenicum	1	1.37
混合感染	15	20.55
M.intracellulare+M.avium	3	4.11
M.intracellulare+M.abscessus subsp.abscessus	4	5.48
M.intracellulare+M.abscessus subsp.bolletii	1	1.37
M.intracellulare+M.gordonae	1	1.37
M.intracellulare+M.chelonae	1	1.37
M.abscessus subsp.abscessus+M.abscessus subsp.bolletii	1	1.37
M.abscessus subsp.abscessus+M.immunogenum	1	1.37
M.abscessus subsp.abscessus+M.nonchromogenicum	1	1.37
M.kansasii+M.simiae	1	1.37
M.abscessus subsp.abscessus+M.intracellulare+M.avium	1	1.37

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表 3 Xpert与MALDI-TOF MS对NTM肺病和肺结核诊断的一致性评价

Table 3. Evaluation of the consistency between Xpert and MALDI-TOF MS in the diagnosis of NTM pulmonary disease and pulmonary tuberculosis

检测方法	例数(n=122)	MALDI-TOF MS		Kappa检验
检测方法	例数(n=122)	NTM肺病组	肺结核组	Kappa值	P值
AFB⁺Xpert^-	51	51	0	0.938^a	< 0.001^a
AFB⁺Xpert⁺	39	1	38
AFB^-Xpert^-	24	21	3	0.568^b	< 0.001^b
AFB^-Xpert⁺	8	0	8
注：AFB⁺为AFB涂片阳性；AFB^-为AFB涂片阴性；Xpert⁺为Xpert阳性；Xpert^-为Xpert阴性；^a为AFB⁺Xpert^-与AFB⁺Xpert⁺比较；^b为AFB^-Xpert^-与AFB^-Xpert⁺比较。

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