564例肺结核患者痰标本质量对检测结果的影响  

Analysis of the influence of sputum sample quality on diagnostic outcome in 564 cases of pulmonary tuberculosis

作　　者：杨新宇[1] 李波[2] 赵琰枫 王嫩寒[1] 张洁[1] 易俊莉[1] 田丽丽[1] 任怡宣 樊瑞芳 赵文娟 陈昊 陈双双 代小伟 丁北川[1] YANG Xin-yu;LI Bo;ZHAO Yan- feng;WANG Nen-han;ZHANG Jie;YI Jun-li;TIAN Li-li;REN Yi-xuan;FAN Rui-Jang;ZHAO Wen-juan;CHEN Hao;CHEN Shuang-shuang;DAI Xiao-wei;DING Bei-chuan(Central Laboratory of Beijing Research Institute for Tuberculosis Control, Beijing 100035, China)

机构地区：[1]北京结核病控制研究所中心实验室,100035 [2]北京结核病控制研究所中心门诊部,100035

出　　处：《结核病与肺部健康杂志》2018年第2期109-113,共5页Journal of Tuberculosis and Lung Health

摘　　要：目的 分析初诊肺结核患者留取痰标本的质量对于细菌学检查结果的影响,为临床诊断及指导留取高质量痰标本提供参考。方法 采用回顾性调查方法,对2016年1月至2017年12月就诊于北京结核病控制研究所的564例初诊肺结核患者的痰标本进行抗酸杆菌涂片镜检和分枝杆菌培养检查（包括固体培养和液体培养）,不同性状痰标本的阳性率、阳性分级情况及不同培养方法的阳性率均采用SPSS 17.0软件进行统计学分析,计数资料的比较采用χ 2检验,以P〈0.05为差异有统计学意义。 结果 每例初诊肺结核患者留取3份痰标本进行抗酸杆菌涂片检查,并选取2份性状较好的痰标本同时进行分枝杆菌培养检查,564例患者共留取痰标本1692份,标本合格率67.3%（1138/1692）;确诊242例,占42.9%（242/564）;3份留取的痰标本均合格者311例,占55.1%（311/564）。涂片、固体培养、液体培养检测在合格痰标本中的阳性率分别为21.1%（240/1138）、37.4%（258/690）和68.0%（68/100）;在不合格痰标本中的阳性率分别为3.4%（19/554）、16.2%（49/302）和27.8%（10/36）;在合格与不合格痰标本中各类检测技术阳性率比较,差异均有统计学意义（χ 2值分别为89.64、44.04、17.51,P值均〈0.001）。 结论 初诊肺结核患者痰标本合格率较低,合格痰标本的分枝杆菌检出率明显高于不合格痰标本,故重视并提高留取痰标本的质量显得十分重要。Objective To analyze the influence of the quality of sputum samples collected from patients with newly diagnosed pulmonary tuberculosis on the results of bacteriological examinations, to provide a reference for clinical diagnosis and guidance on the importance of collecting good quality sputum samples.Methods A retrospective investigation was conducted on 564 sputum samples obtained from patients newly diagnosed with pulmonary tuberculosis at the Beijing Research Institute for Tuberculosis Control between January 2016 and December 2017. AFB smears and mycobacterium culture （including solid culture and liquid culture） were performed. The positive rate and positive grade of different qualities of sputum samples, and the positive rate obtained with different culture methods were analyzed using SPSS 17.0. Chi-square tests were used for comparing counting data. P〈0.05 was considered statistically significant.Results Three sputum samples were collected for AFB examination per newly diagnosed tuberculosis case, and two sputum samples were simultaneously used for mycobacterial culture. A total of 1692 sputum samples were collected from 564 patients, 67.3% （1138/1692） of which passed quality grading. 242 cases （42.9%, 242/564） of pulmonary tuberculosis were confirmed. In 311 cases （55.1%, 311/564）, all three sputum samples were of sufficient quality. Positive rates obtained for smears, solid culture, and liquid culture for sputum samples considered to be of sufficient quality were 21.1% （240/1138）, 37.4% （258/690）, and 68.0% （68/100）, respectively, while that for sputum samples of poorer quality were 3.4% （19/554）, 16.2% （49/302） and 27.8% （10/36）, respectively. The differences in positive rates between sputum samples of good quality and those of poorer quality were statistically significant in all the tests used （χ 2 values were 89.64, 44.04, and 17.51, respectively; Ps〈0.001）. Conclusion The rate of good quality sputum samples obtained from newly diagnosed pulmonary tuber

关 键 词：结核 肺 痰 标本制备 细菌学技术 因素分析 统计学 结果评价(卫生保健) 

分 类 号：R521[医药卫生—内科学]