抗酸杆菌液基薄层涂片方法的临床应用研究
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摘要
目的评价结核分枝杆菌液基薄层涂片法对不同类型标本的染色检查效能。方法对200份住院1周内结核病患者的标本同时进行液基薄层方法与直接涂片法镜检抗酸杆菌,其中包括148份晨痰标本,52份体液标本,比较2种方法的阳性检出率。结果排除16份重复标本,9份未进行分枝杆菌培养的标本,纳入的123份痰标本中,液基薄层法阳性率33.33%,直接涂片法阳性率24.39%,差异有统计学意义(P=0.012);培养阳性病例的痰标本中,液基薄层法阳性率58.82%,直接涂片法阳性率44.12%,差异有统计学意义(P=0.018)。52份体液标本中,液基薄层法阳性率13.46%,直接涂片阳性率1.96%,差异有统计学意义(P=0.041);培养阳性病例的16份体液标本中,液基薄层法阳性比例为7/16,直接涂片法阳性比例为1/16,差异有统计学意义(P=0.040)。结论基于液基薄层方法的抗酸杆菌涂片阳性率高于直接涂片法,对于体液标本阳性率提高显著,有利于临床上快速诊断,但对于痰标本的应用须综合考虑检验时长和检验费用。
Objective To evaluate the diagnostic performance of smear method based on liquid-based cytology in detecting acid-fast bacilli in clinical specimens of different types. Methods A total of 200 samples including 148 samples of morning sputum and 52 samples of body fluid, which were collected from patients within one week since they were hospitalized, were examined for acid-fast bacilli by direct smear method and liquid-based smear method at the same time. The positive rates of the two methods were compared. Results Sixteen repeated samples and 9 samples without being cultured for acid-fast bacilli were excluded, so 123 samples of morning sputum and 52 samples of body fluid were included. As for 123 sputum samples, the positive rates were 33.33% for liquid-based smear method and 24.39% for direct smear method, and the difference was significant(P=0.012); the positive rates were 58.82% for liquid-based smear method and 44.12% for direct smear method in culture-confirmed sputum samples, and the difference was significant(P=0.018). As for 52 samples of body fluid, the positive rates were 13.46% for liquid-based smear method and 1.96% for direct smear method, and the difference was significant(P=0.041); 7 samples were positive for liquid-based smear method and 1 for direct smear method in culture-confirmed sputum samples(16 samples), and the difference was significant(P=0.040). Conclusions The positive rate of detecting acid-fast bacilli by liquid-based smear method is higher than that by direct smear method, especially for body fluid specimens. The liquid-based smear method is useful for clinical rapid diagnosis. However, for the sputum specimens, the examination time and the cost should be considered.
Objective To evaluate the diagnostic performance of smear method based on liquid-based cytology in detecting acid-fast bacilli in clinical specimens of different types. Methods A total of 200 samples including 148 samples of morning sputum and 52 samples of body fluid, which were collected from patients within one week since they were hospitalized, were examined for acid-fast bacilli by direct smear method and liquid-based smear method at the same time. The positive rates of the two methods were compared. Results Sixteen repeated samples and 9 samples without being cultured for acid-fast bacilli were excluded, so 123 samples of morning sputum and 52 samples of body fluid were included. As for 123 sputum samples, the positive rates were 33.33% for liquid-based smear method and 24.39% for direct smear method, and the difference was significant(P=0.012); the positive rates were 58.82% for liquid-based smear method and 44.12% for direct smear method in culture-confirmed sputum samples, and the difference was significant(P=0.018). As for 52 samples of body fluid, the positive rates were 13.46% for liquid-based smear method and 1.96% for direct smear method, and the difference was significant(P=0.041); 7 samples were positive for liquid-based smear method and 1 for direct smear method in culture-confirmed sputum samples(16 samples), and the difference was significant(P=0.040). Conclusions The positive rate of detecting acid-fast bacilli by liquid-based smear method is higher than that by direct smear method, especially for body fluid specimens. The liquid-based smear method is useful for clinical rapid diagnosis. However, for the sputum specimens, the examination time and the cost should be considered.
引文
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[4]王永怡,王姝,张云辉,等.2015年全球传染病相关热点回顾[J].传染病信息,2016,29(1):30-34.
[5]Molicotti P,Bua A,Zanetti S.Cost-effectiveness in the diagnosis of tuberculosis:choices in developing countries[J].J Infect Dev Ctries,2014,8(1):24-38.
[6]梁湘晖,宋婕,刘文恩.液基集菌制片技术检测抗酸杆菌的临床应用研究[J].中国防痨杂志,2009,31(2):86-89.
[7]成灿.液基夹层法检测灌洗液穿刺液中结核杆菌的临床应用[J].中国现代医学杂志,2012,22(32):83-85.
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