痰与支气管肺泡灌洗液结核分枝杆菌FQ-PCR检测对涂阴肺结核诊断价值的比较  

The diagnosis value comparison of Mycobacterium tuberculosis by FQ-PCR in samples for smear-negative pulmonary tuberculosis

作　　者：张宏英[1] 陈力舟[1] 林敏[1] 吕骁[1] 杨国育[1] 毛雅云[1] 李天林[1] 王岗玲[1] 

机构地区：[1]福建医科大学教学医院福州肺科医院内二区,350008

出　　处：《中国防痨杂志》2011年第12期806-809,共4页Chinese Journal of Antituberculosis

摘　　要：目的探讨呼吸道痰标本和支气管肺泡灌洗液(BALF)Mtb-DNA检测对涂阴肺结核的诊断价值。方法选择福州肺科医院2009年7月至2009年12月胸部影像学疑为肺结核但至少3份痰涂片镜检Mtb阴性,或胸部影像学无法排除肺结核需进一步检查的患者共51例,所有入选患者初诊根据临床症状、体征、胸部影像学结果分为疑似结核组(24例)和待排结核组(27例)。均行抗结核抗体、红细胞沉降率检测及PPD试验,应用实时荧光定量聚合酶链反应(FQ-PCR)定性及定量检测两组患者痰和BALF中的Mtb-DNA。结果疑似结核组和待排结核组各有22例和2例确诊肺结核,确诊的24例中痰FQ-PCR敏感度为45.8%(11/24),特异度为96.3%(26/27),Youden指数42.1%;BALF FQ-PCR的敏感度为75.0%(18/24),特异度96.3%(26/27),Youden指数71.3%。结论 FQ-PCR检测BALF Mtb较痰更为敏感,对影像学疑诊但痰涂片阴性的结核患者有很高的实用价值,尤其适用于无痰的患者。Objective To evaluate the diagonsis value of M.tuberculosis DNA detected by fluorescence quantitative polymerase chain reaction（FQ-PCR） in sputum and bronchoalveolar lavage fluid（BALF） for patients with smear-negative suspicious pulmonary tuberculosis（PTB）.Methods Fifty one suspicious lung tuberculosis patients from July to December in 2009 with at least three times negative sputum smear are divided into two groups： 24 cases with suspicious radiological features of pulmonary tuberculosis（suspicious PTB group） and 27 cases with radiological features of non-tuberculosis（excluding PTB group）.All of patients underwent tuberculin skin test,anti-TB antibody and erythrocyte sedimentation rate（ESR） are detected,Mtb-DNA of sputum and BALF are detected qualitatively and quantitatively by FQ-PCR.Results Sputum specimens PCR has a sensitivity of 45.8%（11/24）,specificity of 96.3%（26/27）,and Youden＇s index of 42.1%,whereas in BALF specimens,the sensitivity and Youden＇s index are significantly higher at 75.0%（18/24） and 71.3% respectively,while the specificity is still high at 96.3%（26/27）.Conclusion Detecting Mtb-DNA in BALF by FQ-PCR is more sensitive than sputum specimens,and has a good diagnostic yield in patients with suspicious radiological features and sputum smear-negative pulmonary tuberculosis,especially without sputum production.

关 键 词：结核 肺/诊断 分枝杆菌 结核 DNA 细菌 支气管肺泡灌洗液 痰 

分 类 号：R521[医药卫生—内科学]