不同病原学检测方法对肺结核复治确诊的价值分析  

Analysis of the value of different etiological methods in the diagnosis of retreatment of pulmonary tuberculosis

作　　者：潘育文[1] 肖海浩[1] 汤春梅[1] 张言斌[1] 苏铎华[1] 张琳[1] 李天义[1] PAN Yuwen;XIAO Haihao;TANG Chunmei;ZHANG Yanbin;SU Duohua;ZHANG Lin;LI Tianyi(Guangzhou Chest Hospital,Guangzhou 510095,China;不详)

机构地区：[1]广州市胸科医院,广东广州510095

出　　处：《现代医院》2021年第6期975-978,共4页Modern Hospitals

基　　金：广州市高水平临床重点专科和培育专科建设项目(穗卫函[2019]1555号);广州市医学重点学科(结核病学)建设项目。

摘　　要：目的评价不同结核菌病原学检测方法对肺结核复治确诊的应用价值。方法收集广州市胸科医院结核内科2019年1月-12月间收治的323例拟诊为肺结核复治住院患者的临床资料,最后确诊为肺结核复治92例,非活动性肺结核231例,同时用涂片找抗酸杆菌,分枝杆菌培养,Gene Xpert MTB/RIF及SAT-TB检测痰或BALF标本,比较不同检测方法的诊断价值。结果在肺结核复治确诊病例组中Gene Xpert MTB/RIF的阳性检出率为95.65%,分枝杆菌培养为89.13%,SAT-TB为78.26%,涂片法为69.57%,Gene Xpert MTB/RIF和分枝杆菌培养的阳性检出率明显高于SAT-TB和涂片法(P<0.05)。以临床确诊肺结核复治作为标准,涂片找抗酸杆菌的灵敏度为69.57%,特异度为91.77%,Youden指数为0.6134;分枝杆菌培养的灵敏度为89.13%,特异度为84.42%,Youden指数为0.7355;Gene Xpert MTB/RIF的灵敏度为95.65%,特异度为93.93%,Youden指数为0.8958;SAT-TB的灵敏度为78.26%,特异度为98.70%,Youden指数为0.7696。结论Gene Xpert MTB/RIF具有较高的灵敏度,SAT-TB有较高的特异度,这两种分子生物学检测方法对临床快速诊断肺结核复治有着重要的应用价值,涂片和培养作为传统的检测手段,仍具有不可替代的作用,多种方法联合应用,结合临床分析,能对肺结核复治进行快速、准确的诊断。Objective To evaluate the diagnostic value of different Mycobacterium tuberculosis pathogen detection Methods in retreatment of pulmonary tuberculosis.Methods The clinical data of 323 patients suspected diagnosis of retreatment of pulmonary tuberculosis admitted to the department of tuberculosis of Guangzhou chest hospital from January to December 2019 were collected.Finally,92 patients were diagnosed as retreatment of pulmonary tuberculosis and 231 patients were diagnosed as non-active pulmonary tuberculosis.Meanwhile,smear for acid-fast bacilli,mycobacterium culture,Gene Xpert MTB/RIF and SAT-TB were used to detect sputum or BALF samples,and the diagnostic value of different methods was compared.Results The positive detection rate of Gene Xpert MTB/RIF,mycobacterium culture,SAT-TB and smear method was 95.65%,89.13%,78.26%and 69.57%respectively in the retreatment case group of pulmonary tuberculosis.The positive detection rate of Gene Xpert MTB/RIF and mycobacterium culture was significantly higher than that of SAT-TB and smear method(P<0.05).Clinical diagnosis of retreatment of pulmonary tuberculosis was taken as the standard,the sensitivity,specificity and Youden index of smear were 69.57%,91.77%and 0.6134 respectively;the sensitivity,specificity and Youden index of mycobacterium culture were 89.13%,84.42%and 0.7355 respectively;the sensitivity,specificity and Youden index of Gene Xpert MTB/RIF were 95.65%,93.93%and 0.8958 respectively;the sensitivity,specificity and Youden index of SAT-TB were 78.26%,98.70%and 0.7696 respectively.Conclusion Gene Xpert MTB/RIF has high sensitivity and SAT-TB has high specificity.These two molecular biological detection methods have important clinical application value in the rapid diagnosis of retreatment of pulmonary tuberculosis.Smear and culture,as traditional detection methods,still play an irreplaceable role.The combination of various Methods and comprehensive clinical analysis can make a rapid and accurate diagnosis of retreatment of pulmonary tuberculosis.

关 键 词：肺结核 复治 检测方法 

分 类 号：R521[医药卫生—内科学] R446[医药卫生—临床医学]