四种病原学方法在检测痰液标本中结核杆菌的诊断价值对比  

Comparative study on the diagnostic value of four pathogenic methods in the detection of Mycobacterium tuberculosis in sputum specimens

作　　者：刘宁[1] 付洪义[1] 孙金昊[1] 刘明 陶磊[1] LIU Ning;FU Hong-yi;SUN Jin-hao;LIU Ming;TAO Lei(Hebei Chest Hospital,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院,石家庄050041

出　　处：《公共卫生与预防医学》2021年第6期107-110,共4页Journal of Public Health and Preventive Medicine

基　　金：河北省重点科技研究计划“RNA恒温扩增技术对肺结核患者诊断与治疗评价的临床研究”(20160493)。

摘　　要：目的探讨抗酸染色、结核菌培养、结核菌DNA检测(TB-DNA)、结核菌RNA恒温扩增技术(SAT-TB)在痰液标本结核杆菌中的检测价值差异。方法选择河北省胸科医院2015年9月至2019年9月之间住院治疗的肺结核患者200例以及非结核肺病患者80例的资料分析。患者入院后采集痰液标本,分析抗酸染色、结核菌培养、TB-DNA、SAT-TB在痰液标本结核杆菌中的检测价值。结果抗酸染色、结核菌培养、TB-DNA、SAT-TB 4种诊断方法的灵敏度、准确度、阳性预测值、阴性预测值数据差异有统计学意义(P<0.05)。灵敏度、准确度和阴性预测值方面,数值上均为SAT-TB>TB-DNA>结核菌培养>抗酸染色,阳性预测值方面,SAT-TB、TB-DNA、结核菌培养的数值高于抗酸染色。4种方法和金标准的Kappa值分别为:Kappa(抗酸染色)=0.145,Kappa(结核菌培养)=0.395,Kappa(TB-DNA)=0.602,Kappa(SAT-TB)=0.770。结论抗酸染色、结核菌培养、TB-DNA、SAT-TB 4种诊断方法均具有一定的检测价值且具有各自的优势及缺陷,SAT-TB优势更大,特异度高,敏感度好,检测时间较短,能够快速鉴别菌种并区分是否活菌。Objective To explore the different diagnostic values of acid-fast staining,tuberculosis culture,tuberculosis DNA detection(TB-DNA),tuberculosis RNA constant temperature amplification technology(SAT-TB)in the detection of Mycobacterium tuberculosis in sputum specimens.Methods A total of 200 pulmonary tuberculosis patients and 80 non-tuberculosis patients who were hospitalized in Hebei Chest Hospital between September 2015 and September 2019 were selected for this study.Sputum samples were collected after admission,and the detection values of acid-fast staining,tuberculosis culture,TB-DNA,and SAT-TB in sputum samples were statistically analyzed.Results The differences in the sensitivity,accuracy,positive predictive value,and negative predictive values of the four diagnostic methods of acid-fast staining,tuberculosis culture,TB-DNA,and SAT-TB were statistically significant(P<0.05).In terms of diagnostic sensitivity,accuracy and negative predictive value,the values were SAT-TB>TB-DNA>tuberculosis culture>acid-fast staining.In terms of the positive predictive value of diagnosis,the values of SAT-TB,TB-DNA,and tuberculosis culture were higher than that of acid-fast staining.The Kappa values of the four methods and the gold standard were:Kappa(acid-fast staining)=0.145,Kappa(tuberculosis culture)=0.395,Kappa(TB-DNA)=0.602,and Kappa(SAT-TB)=0.770.Conclusion The four diagnostic methods of acid-fast staining,tuberculosis culture,TB-DNA,and SAT-TB all had certain detection value with their advantages and disadvantages.SAT-TB was a better detection method with high specificity,good sensitivity,and a short detection timer,which could quickly identify bacteria and distinguish live bacteria.

关 键 词：病原学检测 痰液 结核杆菌 抗酸染色 诊断效率 

分 类 号：R183.3[医药卫生—流行病学] R521[医药卫生—公共卫生与预防医学]