酶联免疫斑点法联合肺泡灌洗液结核菌Xpert检测在涂阴肺结核的诊断价值
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摘要
目的探讨酶联免疫斑点法联合肺泡灌洗液结核菌Xpert检测在涂阴肺结核的诊断价值。方法选择2015年8月至2016年8月该院收治的68例涂阴肺结核患者作为研究对象,采用酶联免疫斑点法及肺泡灌洗液结核菌Xpert检测,将酶联免疫斑点法及结核菌Xpert检测结果与痰培养结果相比,分析其对涂阴肺结核的诊断价值。结果肺结核患者临床表现以夜间盗汗、发热、咳嗽、咳痰为主;X射线、CT检查结果以斑片影云絮影多见。联合检查对于不同类型肺结核的诊断正确率明显高于单独采用酶联免疫斑点法或结核菌Xpert检测,差异有统计学意义(P<0.05)。酶联免疫斑点法诊断的灵敏度为88.46%,特异度为69.05%,准确度为76.47%;结核菌Xpert检测诊断的灵敏度为80.77%,特异度为52.38%,准确度为63.23%;联合检测诊断的灵敏度为92.30%,特异度为78.57%,准确度为83.82%;联合检测对诊断涂阴肺结核的灵敏度、特异度及准确度均有显著提高,差异有统计学意义(P<0.05)。结论酶联免疫斑点法联合肺泡灌洗液结核菌Xpert检测对诊断涂阴肺结核具有重要价值,是一种简便、快速、高效的检查方法。
Objective To investigate the diagnostic value of enzyme-linked immunosorbent assay combined with bronchoalveolar lavage fluid tuberculosis Xpert detection in smear negative pulmonary tuberculosis.Methods From August 2015 to August 2016,68 cases of smear negative pulmonary tuberculosis,admitted in the hospital,were enrolled in the study.Enzyme-linked immunosorbent assay and bronchoalveolar lavage fluid tuberculosis Xpert detection were used in the study.The results of enzyme-linked immunosorbent assay and tuberculosi sXpert detection were compared with sputum culture results,and their diagnostic values for smear negative pulmonary tuberculosis were analyzed.Results The clinical manifestations of pulmonary tuberculosis were mainly nocturnal sweating,fever,cough and expectoration.The results of X-ray and CT examinations showed that the lesions were mostly patchy or in cloudy opacity.The diagnostic accuracy of the combined examination for different types of pulmonary tuberculosis was significantly higher than single detection of enzyme-linked immunosorbent assay or tuberculosis Xpert detection,and the difference was statistically significant(P<0.05).The sensitivity of enzyme-linked immunosorbent assay was 88.46%,the specificity was69.05%,and the accuracy was 76.47%;the sensitivity of tuberculosis Xpert detection was 80.77%,the specificity was 52.38%,and the accuracy was 63.23%;the sensitivity of the combined detection was 92.30%,the specificity was 78.57%,and the accuracy was 83.82%;the sensitivity,the specificity and the accuracy of the combined detection for diagnosis of smear negative pulmonary tuberculosis were significantly increased,and the difference was statistically significant(P<0.05).Conclusion The enzyme-linked immunosorbent assay combined with bronchoalveolar lavage fluid tuberculosis Xpert detection has important value in the diagnosis of smear negative pulmonary tuberculosis.It is a simple,rapid and effective method of examination.
Objective To investigate the diagnostic value of enzyme-linked immunosorbent assay combined with bronchoalveolar lavage fluid tuberculosis Xpert detection in smear negative pulmonary tuberculosis.Methods From August 2015 to August 2016,68 cases of smear negative pulmonary tuberculosis,admitted in the hospital,were enrolled in the study.Enzyme-linked immunosorbent assay and bronchoalveolar lavage fluid tuberculosis Xpert detection were used in the study.The results of enzyme-linked immunosorbent assay and tuberculosi sXpert detection were compared with sputum culture results,and their diagnostic values for smear negative pulmonary tuberculosis were analyzed.Results The clinical manifestations of pulmonary tuberculosis were mainly nocturnal sweating,fever,cough and expectoration.The results of X-ray and CT examinations showed that the lesions were mostly patchy or in cloudy opacity.The diagnostic accuracy of the combined examination for different types of pulmonary tuberculosis was significantly higher than single detection of enzyme-linked immunosorbent assay or tuberculosis Xpert detection,and the difference was statistically significant(P<0.05).The sensitivity of enzyme-linked immunosorbent assay was 88.46%,the specificity was69.05%,and the accuracy was 76.47%;the sensitivity of tuberculosis Xpert detection was 80.77%,the specificity was 52.38%,and the accuracy was 63.23%;the sensitivity of the combined detection was 92.30%,the specificity was 78.57%,and the accuracy was 83.82%;the sensitivity,the specificity and the accuracy of the combined detection for diagnosis of smear negative pulmonary tuberculosis were significantly increased,and the difference was statistically significant(P<0.05).Conclusion The enzyme-linked immunosorbent assay combined with bronchoalveolar lavage fluid tuberculosis Xpert detection has important value in the diagnosis of smear negative pulmonary tuberculosis.It is a simple,rapid and effective method of examination.
引文
[1]孙晶.调查分析结核病流行病学疫情现状及其控制对策[J].中国公共卫生,2015,30(A03):67-68.
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[3]ZHANG Z X,SNG L H,YONG Y,et al.Delays in diagnosis and treatment of pulmonary tuberculosis in AFB smear-negative patients with pneumonia[J].Int J Tuberc Lung Dis,2017,21(5):544-549.
[4]高春景,朱述阳.支气管肺泡灌洗液行Xpert MTB/RIF检测对涂阴肺结核的诊断价值[J].临床肺科杂志,2016,21(12):2192-2196.
[5]肖东楼,赵明刚,王宇,等.中国结核病防治规划实施工作指南(2008年版)[M].北京:中国协和医科大学出版社,2009:27-29.
[6]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[7]杜正新,何佩贤.涂阴与涂阳肺结核患者发现方式及发现初期临床症状和体征的对比分析[J].中国防痨杂志,2016,38(11):940-944.
[8]黄飞,刘二勇,夏愔愔,等.2005-2014年全国涂阴肺结核报告发病与死亡现状分析[J].中国防痨杂志,2015,37(5):473-477.
[9]张晓萍,马红霞,程小飞,等.涂阴老年不典型肺结核的多种CT影像表现[J].临床肺科杂志,2015(8):1484-1486.
[10]LAI D,KOIZIA L,MANEK N,et al.Utility of bronchoalveolar lavage in diagnosis of sputum/smear:negative pulmonary tuberculosis in a non-endemic area with a high proportion of HIV positive patients[J].Am J Respir Crit Care Med,2011,183(5):375-383.
[11]高东花,陈栋军.研究酶联免疫斑点法检测在涂阴肺结核患者的诊断价值[J].中国医药科学,2017,7(13):104-106.
[12]刘琳,吴雪琼,王兰,等.酶联免疫斑点法检测在涂阴肺结核患者的诊断价值[J].北京医学,2015,37(3):220-223.
[13]PANG YU,WANG YUFENG,ZHAO SHUNYING,et al.Evaluation of the xpert MTB/RIF assay in gastric lavage aspirates for diagnosis of smear-negative childhood pulmonary tuberculosis[J].Pediatr Infect Dis J,2014,33(10):1047-1051.
[14]YIN Q Q,JIAO W W,HAN R,et al.Rapid diagnosis of childhood pulmonary tuberculosis by Xpert MTB/RIF assay using bronchoalveolar lavage fluid[J].Biomed Res Int,2014,2014:310194.
[15]张海晴,刘成永,周冬青,等.GeneXpert MTB/RIF系统在结核性胸膜炎快速诊断中应用价值[J].北京医学,2016,38(7):739-741.
[2]薛晓,马艳,刘二勇,等.涂阴肺结核患者的诊断与治疗研究进展[J].中国防痨杂志,2015,37(5):526-530.
[3]ZHANG Z X,SNG L H,YONG Y,et al.Delays in diagnosis and treatment of pulmonary tuberculosis in AFB smear-negative patients with pneumonia[J].Int J Tuberc Lung Dis,2017,21(5):544-549.
[4]高春景,朱述阳.支气管肺泡灌洗液行Xpert MTB/RIF检测对涂阴肺结核的诊断价值[J].临床肺科杂志,2016,21(12):2192-2196.
[5]肖东楼,赵明刚,王宇,等.中国结核病防治规划实施工作指南(2008年版)[M].北京:中国协和医科大学出版社,2009:27-29.
[6]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[7]杜正新,何佩贤.涂阴与涂阳肺结核患者发现方式及发现初期临床症状和体征的对比分析[J].中国防痨杂志,2016,38(11):940-944.
[8]黄飞,刘二勇,夏愔愔,等.2005-2014年全国涂阴肺结核报告发病与死亡现状分析[J].中国防痨杂志,2015,37(5):473-477.
[9]张晓萍,马红霞,程小飞,等.涂阴老年不典型肺结核的多种CT影像表现[J].临床肺科杂志,2015(8):1484-1486.
[10]LAI D,KOIZIA L,MANEK N,et al.Utility of bronchoalveolar lavage in diagnosis of sputum/smear:negative pulmonary tuberculosis in a non-endemic area with a high proportion of HIV positive patients[J].Am J Respir Crit Care Med,2011,183(5):375-383.
[11]高东花,陈栋军.研究酶联免疫斑点法检测在涂阴肺结核患者的诊断价值[J].中国医药科学,2017,7(13):104-106.
[12]刘琳,吴雪琼,王兰,等.酶联免疫斑点法检测在涂阴肺结核患者的诊断价值[J].北京医学,2015,37(3):220-223.
[13]PANG YU,WANG YUFENG,ZHAO SHUNYING,et al.Evaluation of the xpert MTB/RIF assay in gastric lavage aspirates for diagnosis of smear-negative childhood pulmonary tuberculosis[J].Pediatr Infect Dis J,2014,33(10):1047-1051.
[14]YIN Q Q,JIAO W W,HAN R,et al.Rapid diagnosis of childhood pulmonary tuberculosis by Xpert MTB/RIF assay using bronchoalveolar lavage fluid[J].Biomed Res Int,2014,2014:310194.
[15]张海晴,刘成永,周冬青,等.GeneXpert MTB/RIF系统在结核性胸膜炎快速诊断中应用价值[J].北京医学,2016,38(7):739-741.