痰液涂片、支气管刷片抗酸染色联合γ-干扰素释放试验对肺结核的诊断价值  

Value of sputum smear, bronchial brush acid fast staining combined with interferon gamma release assays in thediagnosis of pulmonary tuberculosis

作　　者：张波 张涛[2] 张茜 朱武 谢万华 吕晓玥 ZHANG Bo;ZHANG Tao;ZHANG Qian;ZHU Wu;XIE Wan-hua;LV Xiao-yue(Department of Clinical Laboratory,Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,Shaanxi,CHINA;Department of Clinical Laboratory,Ankang Central Hospital,Ankang 725000,Shaanxi,CHINA;College of Life Sciences,Northwest University,Xi'an 710069,Shaanxi,CHINA)

机构地区：[1]安康市中医医院检验科,陕西安康725000 [2]安康市中心医院检验科,陕西安康725000 [3]西北大学生命科学学院,陕西西安710069

出　　处：《海南医学》2021年第21期2759-2762,共4页Hainan Medical Journal

摘　　要：目的研究痰液涂片、支气管刷片抗酸染色联合γ-干扰素释放试验对肺结核的诊断价值。方法选择2017年1月至2020年9月在安康市中医医院呼吸内科接诊的469例肺结核患者作为研究对象。比较痰液涂片、支气管刷片抗酸染色、γ-干扰素释放试验对结核病患者的检出率以及检查结果的特异度与灵敏度。结果支气管镜下对患者的支气管黏膜观察发现,所有患者的支气管黏膜存在不同程度的炎症情况,其中217例患者有明显的充血、水肿,84例患者有明显的黏膜增厚、粗糙的情况,77例患者有肺段出血的情况,42例患者黏膜壁有明显的淡黄色颗粒状结节,28例患者存在肉芽肿改变的情况,21例患者纤支镜检查无明显的异常改变。痰液涂片、支气管刷片抗酸染色联合γ-干扰素释放试验检出率为92.75%,明显高于痰液涂片抗酸染色、支气管刷片抗酸染色、γ-干扰素释放试验单一检查的检出率(分别为55.22%、79.10%、84.22%),差异均有统计学意义(P<0.05)。痰液涂片、支气管刷片抗酸染色联合γ-干扰素释放试验的灵敏度与特异度(83.58%、98.00%)均明显高于痰液涂片抗酸染色(14.50%、74.50)、支气管刷片抗酸染色(17.06%、79.93%)、γ-干扰素释放试验(39.02%、95.12%),差异均有统计学意义(P<0.05)。结论痰液涂片、支气管刷片抗酸染色联合γ-干扰素释放试验对肺结核诊断有较高的特异度与灵敏度。Objective To study the diagnostic value of sputum smear,bronchial brush acid fast staining combined with interferon gamma release assays for pulmonary tuberculosis.Methods A total of 469 patients with pulmonary tuberculosis,who admitted to Department of Respiratory Medicine,Ankang Hospital of Traditional Chinese Medicine from January 2017 to September 2020,were selected as the subjects.The detection rate,specificity and sensitivity of sputum smear,bronchial brush acid fast staining and interferon gamma release assays in patients with tuberculosis were compared.Results Bronchoscopy showed that there were different degrees of inflammation in the bronchial mucosa of all patients,among them,217 patients had obvious hyperemia and edema,84 patients had obvious mucosal thickening and coarseness,77 patients had segmental hemorrhage,42 patients had obvious yellowish granular nodules on the mucosal wall,28 patients had granuloma changes,and 21 patients had no obvious abnormal changes by fiberoptic bronchoscopy.The detection rate of sputum smear,bronchial brush acid fast staining combined with interferon gamma release assays was 92.75%,which was significantly higher than corresponding 55.22%,79.10%,and 84.22%of sputum smear acid fast staining,bronchial brush acid fast staining,and interferon gamma release assays(all P<0.05).The sensitivity and specificity of sputum smear,bronchial brush acid fast staining combined with interferon gamma release assays were 83.58%and 98.00%,respectively,which were significantly higher than corresponding 14.50%and 74.50%,17.06%and 79.93%,39.02%and 95.12%of sputum smear acid fast staining,bronchial brush acid fast staining,interferon gamma release assays(all P<0.05).Conclusion Sputum smear,bronchial brush acid fast staining combined with interferon gamma release assays has high specificity and sensitivity in the diagnosis of pulmonary tuberculosis,which is worthy of clinical promotion.

关 键 词：肺结核 痰液涂片 支气管刷片 抗酸染色 合γ-干扰素释放试验 诊断价值 

分 类 号：R521[医药卫生—内科学]