显微镜观察药物敏感性试验在结核性淋巴结炎中的应用评价  

Evaluafion of microscopic observation drug susceptibility assay for diagnosis of tuberculous lymphadenitis

作　　者：黄自坤[1] 李俊明[1] 程小平[1] 徐晓萌[1] 李玮婷[1] 

机构地区：[1]南昌大学第一附属医院检验科,南昌330006

出　　处：《临床检验杂志》2013年第4期245-248,共4页Chinese Journal of Clinical Laboratory Science

基　　金：江西省卫生厅科技计划资助项目(20081050);江西省科技支撑计划资助项目(2009BSB11219);江西省青年科学家培养计划(2009DQ01900)

摘　　要：目的探讨显微镜观察药物敏感性试验(MODS)用于结核性淋巴结炎的诊断价值及直接进行结核分枝杆菌(MTB)耐药性检测的可能性。方法对94例细针针吸细胞学(FNAC)诊断为结核性淋巴结炎患者,用MODS法、抗酸染色和改良罗氏培养基培养(以下简称罗氏法)对穿刺吸出物进行MTB检测;抗酸染色阳性标本同时用MODS法和绝对浓度法检测药敏,对两法检测结果不符的菌株进行最低抑菌浓度(MIC)测定。结果 MODS法、罗氏法和抗酸染色法检测结核性淋巴结炎的阳性率分别为51.1%、39.4%和22.3%,MODS法阳性率均显著高于罗氏法和抗酸染色法(χ2=7.69与25.04,P均<0.01)。MODS法和罗氏法检测结果的符合率为86.2%。MODS检测时间中位数为13 d,明显短于罗氏培养法的29 d。MODS检测21株MTB对利福平、异烟肼、乙胺丁醇和链霉素药敏结果与罗氏药敏结果符合率分别为95.0%、85.7%、85.7%、100%。7个MODS药敏结果与罗氏药敏检测结果不符,经MIC检测5个药敏结果支持MODS法结果。结论 MODS技术对结核性淋巴结炎诊断和MTB药敏试验检测有较高的敏感性和准确性,在结核病防控中有较好的应用价值。Objective To explored the diagnostic value of microscopic observation drug susceptibility （MODS） assay for tuberculous lymphadenitis and the possibility of drug resistanse test of Mycobacterium tuberculosis （MTB） by direct detection. Methods MTB in the aspirated samples collected from 94 patients with lymph node tuberculosis confirmed by fine needle aspiration cytology （FNAC） were detected by MODS, Lowenstein Jensen （LJ） method and Ziehl-Neelsen （ZN） stain simutaneously. Drug susceptibility of MTB in smear-positive FNAC samples were detected directly by MODS and LJ absolute concentration method, and all the isolates with inconsis- tent results of MODS and LJ method were retested by minimal inhibitory concentration （MIC） method. Results The positive rate of tuberculous lymphadenitis was 51.1% by MODS assay, 39.4% by LJ method and 22.3% by ZN stain respectively. The positive rate of MODS culture was significantly higher than that of LJ method and ZN stain （X2 =7.69 and 25.04,both P 〈0.01 ）. The accordance rate between MODS assay and LJ method was 86.2%. The median time of MODS assay was 13 days. Comparing with 29 days of LJ method, the difference between the two methods was statistically significant. For 21 ZN stain-positive samples, the concordance rate of drug susceptibility detected by MODS and LI method for rifampin, isoniazid, ethambatal and streptomycin were 95.0% , 85.7% , 85.7% and 100% respectively. Inconsistent results between MODS and LJ method were found in 7 isolates among which 5 results of MODS were coincident with MIC method. Conclusion MODS showed high sensitivity and specificity for diagnosis of tuberculous lym- ohadenitis, thus it should be available in the prevention and control of tuberculosis.

关 键 词：结核分枝杆菌 淋巴结炎 针吸活组织检查 药物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]