探讨肺泡灌洗液结核杆菌RNA、培养、涂片检查及结核感染T细胞斑点试验在肺结核诊断中的价值  

The Value of the RNA,Culture,Smear Examination and T-cell Spot Test of Mycobacterium Tuberculosis in Bronchoalveolar Lavage Fluid in Tuberculosis Diagnosis

作　　者：樊亚丽 漆沄 孙欣荣[3] 贺双 FAN Yali;QI Yun;SUN Xinrong;HE Shuang(Department of Graduate,Xi’an Medical College,Xi’an Shaanxi 710021,China;Department of Tuberculosis,Women and Children,Xi’an Chest Hospital,Xi’an Shaanxi 710000,China;Department of Respiratory,Xi’an Children’s Hospital,Xi’an Shaanxi 710003,China)

机构地区：[1]西安医学院研究生处,陕西西安710021 [2]西安市胸科医院妇儿结核科,陕西西安710000 [3]西安市儿童医院呼吸科,陕西西安710003

出　　处：《临床研究》2022年第3期1-4,共4页Clinical Research

基　　金：儿童间质性肺疾病的程序诊断(2017B06)。

摘　　要：目的对219例疑似肺结核患者的肺泡灌洗液进行检测,评估不同检测方法在肺结核病中诊断价值,试寻找一较好的诊断方法。方法此研究对2016年11月至2018年3月的219例疑似为肺结核的患者进行回顾性分析研究,将肺泡灌洗液作为标本,对其进行结核杆菌RNA、培养、涂片检查及结核感染T细胞斑点试验(T-SPOT.TB)检测,对比四种检测方法,评价各自在肺结核病中诊断价值。结果疑似为肺结核的219例患者中最终明确诊断肺结核的有113例,非肺结核的有106例,均行肺泡灌洗液结核杆菌RNA检查、培养、涂片及结核感染T细胞斑点试验,四种检测方法在肺结核病诊断中的灵敏度分别为74.3%,45.1%,39.8%,85.0%;肺泡灌洗液结核杆菌RNA、培养、涂片及结核感染T细胞斑点试验在肺结核病诊断中的特异度分别为99.1%、98.1%、98.1%、93.4%。结论本研究显示将肺泡灌洗液进行T-SPOT.TB检测对肺结核病的诊断具有较高的价值,但不能仅单靠此方法结果来诊治,还应该结合患者临床表现、影像学的改变甚至需结合其他检测方法来共同诊治,从而提高诊断肺结核病灵敏度和特异度,减少误诊及漏诊率,一同作为诊断结核病的依据。Objective To test the alveolar lavage fluid of 219 suspected pulmonary tuberculosis patients and evaluate the diagnostic value of different detection methods in pulmonary tuberculosis,try to find a better diagnostic method.Methods This study conducted a retrospective analysis of 219 patients suspected of pulmonary tuberculosis from November 2016 to March 2018,using the alveolar lavage fluid as a specimen,the tubercular bacterium RNA,culture,smear examination and tuberculosis infection T cell spot test(T-SPOT.TB)were detected,compareing the four test methods to evaluate the diagnostic value of each in pulmonary tuberculosis.Results Of the 219 suspected pulmonary tuberculosis patients,113 were finally diagnosed with pulmonary tuberculosis and 106 were non-TB.All of them underwent alveolar lavage fluid Mycobacterium tuberculosis RNA examination,culture,smear and tuberculosis infection T cell spot test,the sensitivity of the four tests in the diagnosis of pulmonary tuberculosis was 74.3%,45.1%,39.8%,85.0%;the specificity of the tuberculosis lavage fluid tuberculosis RNA,culture,smear and tuberculosis infection T cell spot test in the diagnosis of tuberculosis was 99.1%,98.1%,98.1%,93.4%respectively.Conclusion This study shows that the T-SPOT.TB test of alveolar lavage fluid had high value in the diagnosis of tuberculosis,but it cannot be diagnosed and treated solely by the results of this method;it should also be combined with the patient’s clinical manifestations,imaging changes and other detection methods for joint diagnosis and treatment,the sensitivity and specificity of the diagnosis of pulmonary tuberculosis will be improved,and the rate of misdiagnosis and missed diagnosis will be reduced,which will be used as the basis for the diagnosis of tuberculosis.

关 键 词：肺结核病 肺泡灌洗液 结核杆菌RNA检查 培养 涂片检查 结核感染T细胞斑点试验 

分 类 号：R521.04[医药卫生—内科学]