GeneXpert MTB/RIF Ct预测结核病传染性的有效性

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now Pub Date : 2025-04-06 DOI:10.1016/j.idnow.2025.105061

F. Méchaï , E. Beugre , T. Billard-Pomares , F. Mougari , B. Wyplosz , E. Cambau , N. Vignier

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引用次数: 0

摘要

GeneXpert®MTB/RIF检测在诊断肺结核（pTB）方面比涂片镜检（SM）更快、更敏感。我们评估了GeneXpert MTB/RIF测试的Ct（“周期阈值”）对估计传染性的贡献。方法对经培养阳性和GeneXpert阳性证实的肺结核患者进行多中心回顾性分析。在第0天（D0）计算中位Ct。我们研究了D0上Ct与SM之间的相关性，D0上Ct与培养液中TTD （Time-To-Detection）之间的相关性，以及D0上Ct与D15、第1个月（M1）和M2上培养之间的相关性。结果共纳入426例患者。SM阴性130例（30.6%）。全球中位Ct为20.1。Ct与诊断时SM分级（Xpert MTB/RIF或Xpert MTB/RIF Ultra）显著相关，r = -0.77, p <；0.001, r = -0.69, p <；分别为0.0001)。D0 Ct与TTD显著相关(r = 0.71, p <；0.0001, r = 0.71, p <；0.0001)，阳性培养仅在D15 (p <；0.0001和p <；分别为0.0001)。结论Ct值与涂片分级及诊断时的细菌载量有较好的相关性。涂片镜检对估计传播风险的敏感性较低。因此，GeneXpert检测（及其Ct）可以代替涂片镜检进行诊断，也可以用来估计患者的传染性，特别是在资源匮乏、涂片和培养难以获得的国家。

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Usefulness of the GeneXpert MTB/RIF Ct for predicting tuberculosis infectiousness

Introduction

The GeneXpert® MTB/RIF test is faster and more sensitive than smear microscopy (SM) for the diagnosis of pulmonary tuberculosis (pTB). We evaluated the contribution of the Ct (“Cycle threshold”) of the GeneXpert MTB/RIF test to estimate infectiousness.

Methods

We performed a multicenter retrospective analysis of patients with pTB confirmed by positivity of culture and GeneXpert. The median Ct was calculated on Day 0 (D0). We studied the following correlations: between the Ct and SM on D0, Ct and Time-To-Detection (TTD) of the culture in liquid medium on D0 and then the correlation between the Ct on D0 and the culture on D15, Month 1 (M1), and M2.

Results

A total of 426 patients were included. SM was negative for 130 (30.6 %) patients. The global median Ct was 20.1. The Ct was significantly correlated with the SM grade at diagnosis (Xpert MTB/RIF or Xpert MTB/RIF Ultra, r = -0.77, p < 0.001 and r = -0.69, p < 0.0001, respectively). D0 Ct was significantly correlated with TTD (r = 0.71, p < 0.0001 and r = 0.71, p < 0.0001, respectively) and with a positive culture only on D15 (p < 0.0001 and p < 0.0001, respectively).

Conclusion

The Ct value correlated well with the smear grade and with the bacillary load at diagnosis. Smear microscopy is less sensitive for estimating the risk of transmission. The GeneXpert test (and its Ct) could therefore replace smear microscopy for diagnosis but also for estimating the infectiousness of patients, particularly in low-resource countries where smear and culture are poorly available.

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