改良抗酸染色联合CPA在基层医院诊断肺结核的应用价值  

The application value of modified Ziehl-Neelsen stain combined with crossing priming amplification assay in diagnosis of pulmonary tuberculosis

作　　者：李玉雪[1] 万玲玲[1] 梁芸[1] 陈红岩[1] 柳晓金[2] 安翠平[1] LI Yuxue;WAN Lingling;LIANG Yun(Department of Clinical Laboratory,The First Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第一医院检验科,050011 [2]河北省石家庄市第五医院检验科

出　　处：《河北医药》2018年第10期1517-1519,1523,共4页Hebei Medical Journal

基　　金：石家庄市科技支撑计划项目(编号:131462533)

摘　　要：目的评估改良抗酸染色法、交叉引物恒温扩增(CPA)技术、改良抗酸染色法联合CPA技术和Xpert MTB/RIF技术诊断肺结核的临床应用价值。方法肺结核确诊病例的痰标本共325份,其中涂阳标本81份,同时采用改良抗酸染色法、CPA、改良抗酸染色法联合CPA技术和Xpert MTB/RIF技术对标本进行检测,分析4种方式的阳性检出率。结果 81份涂阳标本,改良抗酸染色法、CPA、改良抗酸染色法联合CPA技术和Xpert MTB/RIF 4种方式的总体阳性检出率分别为91.4%(74/81)、93.8%(76/81)、95.1%(77/81)、98.8%(80/81),4组阴性率比较,差异无统计学意义244份涂阴标本,改良抗酸染色法、CPA、改良抗酸染色法联合CPA技术和Xpert MTB/RIF四种方式的总体阳性检出率分别为20.1%(49/244)、46.7%(114/244)、54.9%(134/244)、54.5%(133/244),改良抗酸染色法阴性率低于CPA技术组、改良抗酸染色法+CPA技术组、Xpert MTB/RIF技术组,差异有统计学意义(P<0.05)。后3组比较,差异无统计学意义(P>0.05);改良抗酸染色法、CPA、改良抗酸染色法联合CPA技术和Xpert MTB/RIF四种方式的总体阳性检出率分别为37.8%(123/325)、58.5%(190/325)、64.9%(211/325)、65.5%(213/325)。结论改良抗酸染色法、CPA技术、改良抗酸染色法联合CPA技术和Xpert MTB/RIF技术对肺结核均具有良好的辅助诊断价值;诊断涂阳及涂阴肺结核时,改良抗酸染色法联合CPA技术可以有效替代高成本的Xpert MTB/RIF检测技术,在基层医院有良好的应用前景。Objective To evaluate the clinical application value of modified Ziehl-Neelsen stain,crossing priming amplification（ CPA） assay,and modified Ziehl-Neelsen stain combined with CPA and Xpert MTB/RIF assay in diagnosis of pulmonary tuberculosis. Methods A total of 325 sputum samples of patients with pulmonary tuberculosis who were diagnosed definitely in our hospital from January 2017 to Qctober 2017 were detected by using modified Ziehl-Neelsen stain,CPA,modified Ziehl-Neelsen stain combined with CPA and Xpert MTB/RIF assay,in which,there were 81 cases of smear-positive specimens and 244 cases of smear-negative specimens. Results Among 81 cases of smear-positive specimens,the positive detection rates of modified Ziehl-Neelsen stain,CPA,modified Ziehl-Neelsen stain combined with CPA and Xpert MTB/RIF assay were 91. 4%（ 74/81）,93. 8%（ 76/81）,95. 1%（ 77/81）,96. 3%（ 78/81）,respectively,there were no significant differences in the positive detection rates among the four detection methods（ P〉 0. 05）. Among 244 cases of smear-negative specimens,the positive detection rates of the four detection methods were 50. 8%（ 124/244）,53. 3%（ 130/244）,65. 6%（ 160/244）,25. 0%（ 61/244）,respectively. The positive detection rate of modified acid fast stain method was significantly lower than that by the other three detection methods（ P〈 0. 05）,however,there were no significant differences among the latter three detection methods（ P〉 0. 05）. Moreover the total positive rates detected by the four detection methods were56. 9%（ 190/325）,58. 5%（ 190/325）,97. 3%（ 244/325）,69. 3%（ 225/325）,respectively. Conclusion The modified Ziehl-Neelsen stain,CPA,modified Ziehl-Neelsen stain combined with CPA and with Xpert MTB/RIF assay have better auxiliary diagnosis value in diagnosis of pulmonary tuberculosis. The modified Ziehl-Neelsen stain combined CPA has obtain best detection results both in smear positive and negative specimens,which can substitute the expensive Xpert MTB/RIF a

关 键 词：结核病 结核分枝杆菌 检测技术 诊断 

分 类 号：R521[医药卫生—内科学]