聚合酶链反应检验应用于肺结核早期诊断的准确性评价  

Accuracy evaluation of polymerase chain reaction in early diagnosis of pulmonary tuberculosis

作　　者：王瑜 Wang Yu(Department of Clinical Laboratory,Yantai Lung Hospital,Yantai 264000,Shandong,China)

机构地区：[1]烟台肺科医院检验科,山东烟台264000

出　　处：《实用检验医师杂志》2022年第4期361-364,共4页Chinese Journal of Clinical Pathologist

摘　　要：目的 探讨聚合酶链反应(PCR)检验应用于肺结核早期诊断的准确性。方法 选择2020年1月—2022年8月在烟台肺科医院就诊的120例疑似肺结核患者作为研究对象,在患者中开展痰涂片检查、结核菌素皮肤试验和PCR检验。以临床综合诊断结果作为诊断“金标准”,比较痰涂片检查、结核菌素皮肤试验和PCR检验对肺结核诊断效能的各项指标(包括敏感度、特异度、准确度、阳性预测值及阴性预测值),分析痰涂片检查、结核菌素皮肤试验和PCR检验对于肺结核的诊断结果与诊断“金标准”结果的一致性,并比较痰涂片检查、结核菌素皮肤试验和PCR检验对不同分期肺结核的诊断符合率。结果 依照诊断“金标准”,在肺结核诊断时,PCR检验的敏感度、特异度、准确度、阳性预测值及阴性预测值均明显高于结核菌素皮肤试验和痰涂片检查(敏感度:96.25%比86.25%、71.25%,特异度:97.50%比82.50%、62.50%,准确度:96.67%比85.00%、68.33%,阳性预测值:98.72%比90.79%、79.17%,阴性预测值:92.86%比75.00%、52.08%,均P<0.05)。采用PCR检验和结核菌素皮肤试验进行肺结核诊断所得结果与病理诊断结果高度一致(κ值分别为0.892、0.745),而采用痰涂片检查所得诊断结果与病理诊断结果的一致性为中度(κ值为0.561)。在活动期和好转期肺结核患者中,PCR检验的诊断符合率均明显高于结核菌素皮肤试验和痰涂片检查[活动期:94.92%(56/59)比83.05%(49/59)、66.10%(39/59),好转期:100.00%(21/21)比80.95%(17/21)、47.62%(10/21),均P<0.05]。结论 采用PCR检验对肺结核具有良好的诊断价值,其诊断准确度优于痰涂片检查和结核菌素皮肤试验,可更加灵敏、准确地检出肺结核,减少误诊和漏诊,还能辅助鉴别和诊断肺结核的分期。Objective To investigate the application accuracy of polymerase chain reaction(PCR) test in the early diagnosis of pulmonary tuberculosis. Methods The 120 patients with suspected pulmonary tuberculosis admitted in Yantai Lung Hospital from January 2020 to August 2022 were selected as the study objects, and sputum smear test, tuberculin skin test and PCR test were carried out in the patients. Taking the clinical comprehensive diagnosis results as "gold standard" for diagnosis, the indicators of sputum smear test, tuberculin skin test and PCR test in the diagnosis of pulmonary tuberculosis were compared(including sensitivity, specificity, accuracy, positive predictive value and negative predictive value). The consistency between the diagnostic results of sputum smear test, tuberculin skin test and PCR test for pulmonary tuberculosis and the diagnostic "gold standard" results was analyzed, and the diagnostic coincidence rates of sputum smear test, tuberculin skin test and PCR test for different stages of pulmonary tuberculosis were compared. Results According to the diagnostic "gold standard", when diagnosing pulmonary tuberculosis,the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PCR test were all significantly higher than those of tuberculin skin test and sputum smear(specificity: 96.25% vs.86.25%, 71.25%, specificity: 97.50% vs. 82.50%, 62.50%, accuracy: 96.67% vs. 85.00%, 68.33%, positive predictive value: 98.72% vs. 90.79%, 79.17%, negative predictive value: 92.86% vs. 75.00%, 52.08%, all P < 0.05). In the diagnosis of pulmonary tuberculosis, the consistency rates between PCR test, tuberculin skin test and pathological diagnosis were high(κ values were 0.892 and 0.745), while the consistency rate between sputum smear and pathological diagnosis was moderate(κ value was 0.561). In the diagnosis of active and improved stages of pulmonary tuberculosis, the diagnostic coincidence rates of PCR test were significantly higher than those of tuberculin skin test and sput

关 键 词：肺结核 诊断 聚合酶链反应检验 痰涂片检查 结核菌素皮肤试验 

分 类 号：R521[医药卫生—内科学]