免疫荧光染色法在基层医院诊断肺结核中的应用价值分析  

Analysis of the value of immunofluorescence staining in the diagnosis of pulmonary tuberculosis in primary hospitals

作　　者：练亿香[1] 罗海军[1] 蒋莎莉[1] LIAN Yixiang;LUO Haijun;Jiang Shali(Department of Pathology,Changsha Central Hospital,Changsha Hunan 410004)

机构地区：[1]长沙市中心医院病理科,湖南长沙410004

出　　处：《当代医药论丛》2023年第10期5-8,共4页

摘　　要：目的:评估肺活检病理组织免疫荧光染色法与TB-DNA-PCR检测法诊断肺结核的一致性,并与抗酸染色法比较,以得出免疫荧光染色法是基层医院可替代TB-DNA检测的快速、准确、经济的检测方法。方法:回顾性分析2022年1月至2022年12月长沙市中心医院收治的考虑肺结核并已做TB-DNA检测和抗酸染色检测的患者387例,分析免疫荧光染色法、抗酸染色法与TB-DNA检测的一致性,以TB-DNA结果为参照,比较其灵敏度、特异度、阳性预测值、阴性预测值的差异,并且评估不同方法联合的诊断性能。结果:免疫荧光染色法与TB-DNA一致性的kappa值为0.746(0.681-0.811)。免疫荧光染色法的受试者工作曲线(ROC)下的面积(AUC)为0.889(95%CI=0.859-0.918)。免疫荧光染色法与抗酸染色法的灵敏度(81.6%vs 49.6%,P<0.001)、阴性预测值(77.4%vs 55.8%,P<0.001)的差异具有统计学意义。病理形态学或免疫荧光染色法联合的敏感度和阴性预测值分别为99.1%(95%CI=96.9%-99.9%)和97.8%(95%CI=92.4%-99.7%)。结论:免疫荧光染色法与TB-DNA法检测结果一致性高,病理形态学和免疫荧光染色法的联合对于肺结核诊断的阴性预测值高,是缺乏分子病理诊断能力的基层医院的潜在替代诊断方案。Objective:To evaluate the consistency of immunofluorescence staining and TB-DNA-PCR in lung biopsy pathological tissue,and compare with Acid-Fast Stain,assess that immunofluorescence staining is a rapid,accurate and economical strategy to replace TB-DNA detection in primary hospitals.Methods:A retrospective analysis was conducted on 387 patients admitted to our hospital who were considered for tuberculosis and had undergone TB-DNA testing and Acid-Fast Stain.The consistency of immunofluorescence staining,Acid-Fast Stain and TB-DNA-PCR was analyzed,and the differences of sensitivity,specificity,PPV and NPV were compared.The diagnostic performance of the combination of different methods is also evaluated.Results:The kappa value between immunofluorescence staining and TB-DNA was 0.746(0.681-0.811).The area(AUC)under receiver operating curve(ROC)of immunofluorescence staining was 0.889(95%CI=0.859-0.918).There were significant differences in sensitivity(81.6%vs 49.6%,P<0.001)and NPV(77.4%vs 55.8%,P<0.001)between immunofluorescence staining and Acid-Fast Stain.The combined sensitivity and NPV of pathomorphology or immunofluorescence staining were 99.1%(95%CI=96.99-99.9%)and 97.8%(95%CI=92.4-99.7%),respectively.Conclusions:The results of immunofluorescence staining and TB-DNA method are highly consistent,and the combination of pathological morphology or immunofluorescence staining has a high NPV for the diagnosis of pulmonary tuberculosis,which is a potential alternative tool for hospitals lacking molecular path ological diagnosis.

关 键 词：TB-DNA 免疫荧光染色法 抗酸染色法 肺结核 阴性预测值 

分 类 号：R446[医药卫生—诊断学]