8种结核病实验室检测方法诊断价值的对比分析  

Tuberculosis(TB) laboratory evaluation of the diagnostic value of eight detection methods

作　　者：李玉静[1] 马京华[2] 张彦坤[1] 张聪瑶 杨永辉[1] 侯宏伟[1] 张珣[1] 王亮[1] 吕莎[1] 

机构地区：[1]河北省胸科医院,石家庄050041 [2]河北中医学院护理学院

出　　处：《医学动物防制》2017年第1期25-28,32,共5页Journal of Medical Pest Control

基　　金：2013年河北省科学技术研究与发展指导计划项目(132777269)

摘　　要：目的分析探讨涂片抗酸染色、荧光染色、夹层杯抗酸染色、改良罗氏培养、BACTEC MGIT 960快速培养、实时荧光定量PCR(FQ-PCR)、r-干扰素释放试验(T-SPOT.TB)以及结核抗体(蛋白芯片法)对结核病的辅助诊断价值。方法选取结核病病例798例为结核病组,其中肺结核621例、肺外结核177例;非结核病病例256例作为对照组,分别对各类标本进行8种方法的检测。结果 8种检测方法敏感度及特异度经Pearson卡方检验,差异均有统计学意义(χ~2=1 451.394,P=0.000;χ~2=126.044,P=0.000)。8种方法之间进行两两比较,敏感度除抗酸染色与荧光染色、夹层杯抗酸染色与BACTEC MGIT 960快速培养、FQ-PCR与结核抗体蛋白芯法间的差异无统计学意义外,其他方法之间差异均有统计学意义;特异度除T-SPOT.TB和结核抗体蛋白芯片与其他方法差异有统计学意义外,其他方法间的差异均无统计学意义。结论 8种检测方法各有优缺点,临床工作中应优势互补,联合检测以缩短诊断时间、提高诊断的准确率。Objective To explore the accessory diagnostic value of applying acid- fast stain smear,fluorescence staining,centrifuging the liquored sputa and collecting bacteria,modified Lowenstein- Jensen culture,BACTEC MGIT 960 system,real-time fluorescent quantitative PCR（ FQ- PCR）,r- IGRA（ T- SPOT. TB） and tuberculosis antibody method（ protein chip） for tuberculosis（ TB）. Methods Selecting 798 cases as tuberculosis（ TB） group with 621 cases of pulmonary tuberculosis,177 cases of extrapulmonary tuberculosis and 256 cases of non- tuberculosis（ TB） cases as control group,respectively for the detection of all kinds of specimens by the eight methods. Results The sensitivity and specificity of the eight kinds of detection methods tested by the Pearson chi- square for difference were statistically significant（ χ2= 1 451. 394,P = 0. 000 and χ2= 126. 044,P= 0. 000）. Pairwise comparison of the eight methods indicates on sensitivity there is no statistically significant difference between three pairs of acid fast stain and fluorescent staining,centrifuging the liquored sputa and collecting bacteria and BACTEC MGIT960 system,and FQ- PCR and tuberculosis antibody protein,but exists obvious difference between other pairs; in terms of specificity,there are no statistical differences between the methods except for r- IGRA（ T- SPOT. TB） and TB antibody protein chip. Conclusion Eight kinds of detection methods each have advantages and disadvantages. In clinical work,method complementarity contributes to shortening the time of diagnosis and improving the diagnostic accuracy.

关 键 词：结核 诊断 联合检测 

分 类 号：R446.9[医药卫生—诊断学]