实时荧光定量PCR在结核病理诊断中的应用  

Application of real-time fluorescent quantitative PCR in pathological diagnosis of tuberculosis

作　　者：袁风菊 王宪伟 徐培[1] 成思颖 李慧[1] 丁兀兀[1] YUAN Feng-ju;WANG Xian-wei;XU Pei;CHENG Si-ying;LI Hui;DING Wu-wu(Department of Pathology,Deyang People's Hospital,Deyang 618000,China)

机构地区：[1]德阳市人民医院病理科,四川德阳618000

出　　处：《诊断病理学杂志》2023年第6期541-544,548,共5页Chinese Journal of Diagnostic Pathology

基　　金：四川省科技计划项目(2022NSFSC0714);德阳市科技计划项目(2022SCZ105)。

摘　　要：目的探讨实时荧光定量PCR(qPCR)在结核病理诊断中的应用价值。方法回顾性分析1323例疑似结核病的石蜡包埋组织qPCR结果,并与临床诊断结果、抗酸染色结果进行对比分析。结果1323例病例中1073例有明确的诊断结果,其中结核阳性率为68.22%(732/1073)。1073例病例中,qPCR阳性率为45.39%、敏感性为0.663、特异性为0.994,肺、胸膜、骨、淋巴结、肠中qPCR敏感性分别为0.706、0.676、0.437、0.678、0.625,特异性分别为0.993、1.000、1.000、1.000、1.000,手术组织阳性率和敏感性分别为48.42%、0.692,均高于活检组织,且差异有统计学意义(P<0.05)。755例同时具有qPCR结果和抗酸染色结果的病例中,qPCR与抗酸染色法符合率75.36%(95%CI 72.17~78.30),qPCR阳性率(43.44%,328/755)高于抗酸染色的阳性率(21.5%,162/755)(P<0.05),qPCR的AUC(95%CI)=0.837(0.817~0.859)高于抗酸染色AUC(95%CI)=0.656(0.634~0.678)(P<0.05),敏感性高于抗酸染色(0.677 vs 0.327)(P<0.05)。结论qPCR在结核病的病理诊断中具有良好的应用价值,联合抗酸染色可以更准确地进行鉴别诊断。Objective To explore the application value of real-time quantitative polymerase chain reaction(qPCR)in the pathological diagnosis of tuberculosis.Methods The qPCR results of 1323 paraffin-embedded tissues with suspected tuberculosis were retrospectively analyzed,and compared with the clinical diagnosis and acid fast staining results.Results Of the 1323 cases,1073 had definite diagnosis result,and the positive rate of tuberculosis was 68.22%(732/1073).In 1073 cases,the positive rate of qPCR was 45.39%,the sensitivity was 0.663,and the specificity was 0.994.The sensitivity of qPCR in lung,pleura,bone,lymph node and intestine was 0.706,0.676,0.437,0.678,0.625,and the specificity was 0.993,1.000,1.000,1.000,1.000,1.000,respectively.The positive rate and sensitivity of surgical tissue were 48.42%and 0.692,respectively,which were higher than those of biopsy tissue,and the difference was statistically significant(P<0.05).In 755 cases with both qPCR and acid-fast staining results,the coincidence rate of qPCR and acid-fast staining was 75.36%(95%CI 72.17-78.30),the positive rate of qPCR(43.44%,328/755)was higher than that of acid-fast staining(21.5%,162/755)(P<0.05).The AUC of qPCR(95%CI=0.837)(0.817,0.859)was higher than that of acid fast staining(95%CI=0.656)(0.634,0.678)(P<0.05),and the sensitivity was higher than that of acid-fast staining(0.677 vs.0.327)(P<0.05).Conclusion qPCR has good application value in the pathological diagnosis of tuberculosis,and the combination of acid fast staining can make a more accurate differential diagnosis.

关 键 词：结核分枝杆菌 石蜡包埋组织 荧光定量PCR 抗酸染色 

分 类 号：R446[医药卫生—诊断学]