结核性腹膜炎实验室诊断的评估  

Values of Different Laboratory Diagnostic Approaches for Tuberculous Peritonitis

作　　者：费贵军[1] 张丽帆[2] 舒慧君[1] FEI Guijun;ZHANG Lifan;SHU Huijun(Department of Gastroenterology,PUMC Hospital, CAMS and PUMC,Beijing 100730,China;Department of Infectious Disease,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院消化内科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院感染内科,北京100730

出　　处：《中国医学科学院学报》2018年第4期534-538,共5页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(81370488)。

摘　　要：目的评价不同的实验室诊断方法对结核性腹膜炎的诊断价值。方法回顾性分析2014年1月至2017年6月在北京协和医院临床以腹腔积液为主要表现,疑诊为结核性腹膜炎患者的病历资料。结果共纳入163例患者,其中男性82例(50.3%)、女性81例(49.7%);年龄15~84岁,平均(50±17)岁;最终诊断为结核性腹膜炎27例(16.6%),排除结核性腹膜炎136例(83.4%)。腹腔积液的抗酸染色、腹腔积液分枝杆菌培养、腹腔积液实时PCR检测结核分枝杆菌DNA、腹腔积液结核感染T细胞检测(免疫斑点法)和外周血结核感染T细胞检测(免疫斑点法)诊断结核性腹膜炎的敏感性分别为0、21.74%、18.52%、95.24%和76.19%,特异性分别为100%、100%、100%、61.90%和80.18%。结论结核性腹膜炎的诊断相对困难,实验室检查方法多种多样但各有不足,需要结合患者的临床表现和辅助检查进行综合分析。Objective To evaluate the diagnostic accuracy of different laboratory approaches for tuberculous peritonitis(TP).Methods The clinical data of patients with suspected TP who were mainly manifested as ascites in Peking Union Medical College Hospital from January 2014 to June 2017 were retrospectively analyzed.Ascites samples were tested with different diagnostic approaches,including acid fast stain,culture for mycobacterium,real-time polymerase chain reaction for identifying DNA of mycobacterium tuberculosis,and T-cell spot of tuberculosis test(T-SPOT.TB).Results Totally 163 cases aged 15-84 years[mean±SD:(50±17)years]with complete data were enrolled,among whom 82(50.3%)were males and 81(49.7%)were females.Finally,27 patients were confirmed as TP,which was excluded in the other 136 cases.The sensitivity and specificity of ascites acid fast stain were 0%and 100%,respectively,followed by ascites culture for mycobacterium(21.74%and 100%),real-time polymerase chain reaction for DNA of mycobacterium tuberculosis in ascites(18.52%and 100%),T-SPOT.TB on ascites(95.42%and 61.90%),and T-SPOT.TB on peripheral blood(76.19%and 80.18%).Conclusions The diagnosis of tuberculous peritonitis remains challenging because of the limitations of the currently available diagnostic tests.Diagnosis should also be based on clinical manifestations and auxiliary examinations.

关 键 词：结核性腹膜炎 诊断 腹腔积液 

分 类 号：R526[医药卫生—内科学]