结核菌RNA检测在肺泡灌洗液中的应用
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摘要
目的比较纤维支气管镜刷检抗酸杆菌(刷片法)、肺泡灌洗液结核分枝杆菌培养(罗氏培养法)、肺泡灌洗液结核菌RNA(TB-RNA)检测三种检测方法对菌阴性肺结核临床诊断应用价值。方法选取2018年1月-12月于安徽省胸科医院疑似肺结核及其它呼吸系统疾病患者各80例,分别予以纤维支气管镜刷检抗酸杆菌、罗氏培养法、TB-RNA检测法,比较其灵敏度和特异性。结果与对照组相比,观察组刷片法、罗氏培养、TB-RNA三种检测方法的阳性率均显著升高,差异有统计学意义,与刷片组、罗氏培养相比,TB-RNA检测的阳性率显著升高,差异有统计学意义。TB-RNA检测方法的敏感性、特异性均高于刷片法与罗氏培养。结论 SAT-TB检测敏感性、特异性、阳性预测值及阴性预测值均高于刷片及罗氏培养,对菌阴肺结核具有较好的诊断价值。
Objective To compare the clinical value of three methods for the diagnosis of bacteria-negative pulmonary tuberculosis,there are fiberoptic bronchoscopy brush test for acid-fast bacilli(brush plate method), alveolar lavage solution for mycobacterium tuberculosis(roche culture method), and alveolar lavage solution for tuberculosis RNA(TB-RNA).Methods 80 patients suspected of pulmonary tuberculosis and other respiratory diseases were selected in anhui provincial chest hospital from January to December, 2018.Those patients were respectively examined by fiberoptic bronchoscopy brush test for acid-resistant bacilli,roche culture method and TB-RNA method, to compare their sensitivity and specificity. Results Compared with the control group, the positive rates of brushing, roche culture and TB-RNA detection in the observation group were significantly increased, with statistically significant differences. Compared with the brushing group and roche culture, the positive rates of TB-RNA detection were significantly increased, with statistically significant differences.The sensitivity and specificity of TB-RNA assay were higher than those of brush culture and roche culture. Conclusion The sensitivity, specificity, positive predictive value and negative predictive value of TB-RNA test were higher than those of brush plate and roche culture.
Objective To compare the clinical value of three methods for the diagnosis of bacteria-negative pulmonary tuberculosis,there are fiberoptic bronchoscopy brush test for acid-fast bacilli(brush plate method), alveolar lavage solution for mycobacterium tuberculosis(roche culture method), and alveolar lavage solution for tuberculosis RNA(TB-RNA).Methods 80 patients suspected of pulmonary tuberculosis and other respiratory diseases were selected in anhui provincial chest hospital from January to December, 2018.Those patients were respectively examined by fiberoptic bronchoscopy brush test for acid-resistant bacilli,roche culture method and TB-RNA method, to compare their sensitivity and specificity. Results Compared with the control group, the positive rates of brushing, roche culture and TB-RNA detection in the observation group were significantly increased, with statistically significant differences. Compared with the brushing group and roche culture, the positive rates of TB-RNA detection were significantly increased, with statistically significant differences.The sensitivity and specificity of TB-RNA assay were higher than those of brush culture and roche culture. Conclusion The sensitivity, specificity, positive predictive value and negative predictive value of TB-RNA test were higher than those of brush plate and roche culture.
引文
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[11]Cowie RI,Langton ME,Escreet BC.Diagnosis of sputumsmear and sputum culture negative pulmonary tuberculosis[J].S Aft Med J,1985,68(12):878.
[12]夏永富,努尔阿米娜·米吉提,白欣煜.经电子支气管镜刷检联合支气管肺泡灌洗对痰菌阴性肺结核患者诊断的意义[J].中国社区医师,2018,34(10):131-132.
[13]施旭东,刘正华,吴晓渊,等.结核分枝杆菌培养和药敏试验及菌群鉴定快速荧光法的研究[J].中华检验医学杂志,2005,28(8):790-792.
[14]葛燕萍,张青.痰标本RNA恒温扩增技术对活动性肺结核的临床诊断价值[J].中国防痨杂志,2016,38(9):742-746.
[2]Mer M,ZumLa A,Dünser M W.Limiting consumption in tuberculosis current concepts in anti-tuberculosis treatment in the critically ill patient[J]Intensive Care Medicine,2018(3):1-3.
[3]WH Organization.Global tuberculosis report 2017[M].Geneva:World Health Organization,2017:1-249.
[4]Almeida C P B,Ziegelmann P K,Couban R,et al.Predictors of In-Hospita Mortality among Patients with Pulmonary Tuberculosis:A Systematic Review and Meta-analysis[J].Scientific Reports,2018,8(1):7230.
[5]Said K,Hella J,Mhalu G,et al.Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam,Tanzania[J].Infectious Diseases of Poverty,2017,6(1):64.
[6]韩丹,段慧楠,饶有益,等.纤维支气管镜灌洗液Xpert MTB/RIF检测对肺结核诊断和利福平耐药菌株筛选的临床价值[J].医学综述,2016,22(16):3243-3246.
[7]楚丽香,孙波,张泽国,等.结核菌RNA与抗酸杆菌涂片及结核菌DNA检测的临床对比分析[J].世界最新医学信息文摘,2017,17(96):175.
[8]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中华结核和呼吸杂志,2001,24(2):70-74.
[9]陈伟,夏愔愔,李涛,等.2015年全球及中国结核病疫情形势分析[J].结核病与肺部健康杂志,2016,5(1):32-36.
[10]唐婧,王庆,徐东芳,等.肺泡灌洗液不同检测方法在肺结核诊断中的临床价值[J].临床肺科杂志,2019,24(01):133-134,182.
[11]Cowie RI,Langton ME,Escreet BC.Diagnosis of sputumsmear and sputum culture negative pulmonary tuberculosis[J].S Aft Med J,1985,68(12):878.
[12]夏永富,努尔阿米娜·米吉提,白欣煜.经电子支气管镜刷检联合支气管肺泡灌洗对痰菌阴性肺结核患者诊断的意义[J].中国社区医师,2018,34(10):131-132.
[13]施旭东,刘正华,吴晓渊,等.结核分枝杆菌培养和药敏试验及菌群鉴定快速荧光法的研究[J].中华检验医学杂志,2005,28(8):790-792.
[14]葛燕萍,张青.痰标本RNA恒温扩增技术对活动性肺结核的临床诊断价值[J].中国防痨杂志,2016,38(9):742-746.