三种快速检测技术诊断早期结核性脑膜炎的评价  

Evaluation of three methods for early etiological diagnosis in patients with tuberculous meningitis

作　　者：郑立恒[1] 柳晓金[5] 冯建纯[1] 章志华[2] 何红彦[3] 邵艳新[4] 陈颜强[3] Li-heng ZHENG;Xiao-jin LIU;Jian-chun FENG;Zhi-hua ZHANG;Hong-yan HE;Yan-xin SHAO;Yan-qiang CHEN(Clinical Laboratory,Chest Hospital of Hebei Province,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院检验科,石家庄050000 [2]河北省胸科医院科教处,石家庄050000 [3]河北省胸科医院神经内科,石家庄050000 [4]河北省胸科医院药剂科,石家庄050000 [5]石家庄市第五医院感染科

出　　处：《中国防痨杂志》2019年第2期186-189,共4页Chinese Journal of Antituberculosis

基　　金：河北省医学科学研究重点课题(ZD20140425).

摘　　要：目的评价3种快速检测技术在早期结核性脑膜炎诊断中的应用价值。方法采用离心涂片抗酸染色法、改良抗酸染色法、GeneXpert MTB/RIF技术(简称“GeneXpert技术”)对2016年8月至2018年6月河北省胸科医院和石家庄市第五医院收治的根据临床表现、影像学及实验室检查等临床确诊的45例结核性脑膜炎、42例非结核性脑膜炎患者的脑脊液标本进行分枝杆菌检测,并对结果进行分析。采用SPSS19.0软件进行统计学分析,率的比较采用χ^2检验、校正χ^2检验,以P<0.05为差异有统计学意义。结果以临床诊断为标准,45例结核性脑膜炎患者脑脊液分别应用离心涂片抗酸染色法、改良抗酸染色法、GeneXpert技术检测分枝杆菌的敏感度分别为4.44%(2/45)、88.89%(40/45)、35.56%(16/45);依次两两比较,差异均有统计学意义(χ^2值分别为64.46、13.16、27.23,P值均=0.000)。42例非结核性脑膜炎患者的脑脊液用离心涂片抗酸染色法、改良抗酸染色法、GeneXpert技术检测分枝杆菌均为阴性。3种检测技术检测分枝杆菌的特异度均为100.00%。结论改良抗酸染色法较离心涂片法及GeneXpert技术检测分枝杆菌阳性率高,具有较好的确诊结核性脑膜炎的价值。Objective To evaluate the clinical value of three methods in early diagnosis of tuberculous meningitis (TBM). Methods The cerebrospinal fluid specimens (CSF) of 45 patients with TBM and the samples of 42 patients with non-TBM were collected from patients admitted to Hebei Chest Hospital and the Fifth Hospital of Shijiazhuang between August 2016 and June 2018. Three methods, including conventional acid fast stain, modified acid fast stain, and GeneXpert MTB/RIF assay were used to detect the mycobacterium in the CSF specimens for diagnosis of TBM. SPSS 19.0 software was used for statistical analysis. The comparison of the rates was made by χ^2 test and corrected χ^2 test, P<0.05 was statistically significant. Results Based on clinical diagnosis, the sensitivity was 4.44% (2/45), 88.89% (40/45), 35.56% (16/45) in the TBM group as tested by conventional acid fast stain, modified acid fast stain, and GeneXpert MTB/RIF assay respectively. There was significant difference between the three methods in the sensitivity (χ^2=64.46, 13.16, 27.23, P=0.000). No mycobacterium was detected in the samples of non-TBM group. The specificity of three detection techniques for mycobacterium was 100.00%. Conclusion The sensitivity of the modified acid fast staining method is higher than that of the conventional acid fast stain and GeneXpert MTB/RIF assay in detection of the mycobacterium in CSF. It is worthwhile for the early diagnosis of TBM.

关 键 词：结核 脑膜 脑脊髓液 早期诊断 实验室技术和方法 对比研究 数据说明 统计 

分 类 号：R529.3[医药卫生—内科学] R446.5[医药卫生—临床医学]