支气管镜检查联合痰TB-RNA、血清TB-SA检测诊断菌阴肺结核  

Bronchoscopy combined with sputum Mycobacterium tuberculosis ribonucleic acid and serum Mycobacterium tuberculosis specific antibody determinations for diagnosis of negative pulmonary tuberculosis

作　　者：孙信林 叶星明 李倩 赵丽君 SUN Xinlin;YE Xingming;LI Qian;ZHAO Lijun(Huai'an Fourth People's Hospital,Huaian 223001,Jiangsu,China;Huai'an Huai'an Hospital,Huaian 223200,Jiangsu,China)

机构地区：[1]淮安市第四人民医院结核科,江苏淮安223001 [2]淮安市淮安医院,江苏淮安223200

出　　处：《检验医学》2023年第9期870-873,共4页Laboratory Medicine

基　　金：国家重大传染病防治科技重大专项定向择优课题(018ZX10722-302)。

摘　　要：目的探讨支气管镜检查联合痰结核分枝杆菌RNA(TB-RNA)、血清结核分枝杆菌特异性蛋白抗体(TB-SA)检测诊断菌阴肺结核的效能。方法选取2018年10月—2019年10月淮安市第四人民医院经痰结核分枝杆菌(MTB)培养确诊的菌阴肺结核患者104例(观察组),以同期80例肺部感染非肺结核患者作为对照组。对所有患者行支气管镜检查。采集所有患者痰样本和血液样本,进行痰TB-RNA和血清TB-SA检测。分析3种方法诊断菌阴肺结核的效能。结果观察组支气管镜检查阳性率(62.50%)显著高于对照组(32.0%),痰TB-RNA检测阳性率(78.85%)显著高于对照组(22.50%),血清TB-SA检测阳性率(68.27%)显著高于对照组(20.00%),差异均有统计学意义(P<0.05)。3种方法联用,诊断肺结核的敏感性显著高于单独支气管镜检查(P<0.001)、TB-RNA检测(P=0.037)和TB-SA检测(P<0.001);准确性显著高于单独支气管镜检查(P<0.001)、TB-RNA检测(P=0.028)和TB-SA检测(P<0.001);特异性差异无统计学意义(P>0.05)。结论支气管镜检查联合痰TB-RNA、血清TB-SA检测可有效提高诊断菌阴肺结核的敏感性。Objective To investigate the efficiency of bronchoscopy combined with sputum Mycobacterium tuberculosis RNA(TB-RNA)and serum Mycobacterium tuberculosis specific antigen(TB-SA)determinations for the diagnosis of negative pulmonary tuberculosis.Methods A total of 104 patients with bacterial-negative pulmonary tuberculosis diagnosed by sputum Mycobacterium tuberculosis(MTB)culture in Huai'an Fourth People's Hospital from October 2018 to October 2019 were enrolled as observation group,and 80 patients with non-pulmonary tuberculosis during the same period were enrolled as control group.Bronchoscopy was performed,sputum samples were collected to determine sputum TB-RNA and serum TB-SA in sputum samples,and the diagnostic efficiency of each determination method for bacterial-negative pulmonary tuberculosis was evaluated.Results The positive rate of bronchoscopy in observation group(62.50%)was higher than that in control group(32.0%)(P<0.05).The positive rate of sputum TB-RNA in observation group(78.85%)was higher than that in control group(22.50%)(P<0.05).The positive rate of serum TB-SA in observation group(68.27%)was higher than that in control group(20.00%)(P<0.05).The sensitivity of the combined determination of the 3 methods was higher than those of bronchoscopy(P<0.001),TB-RNA determination(P=0.037)and TB-SA determination(P<0.001).The accuracy of the combined determination of the 3 methods was higher than those of bronchoscopy(P<0.001),TB-RNA determination(P=0.028)and TB-SA determination(P<0.001).There was no statistical significance in the specificity of the combined determination of the 3 methods(P>0.05).Conclusions Bronchoscopy combined with sputum TB-RNA and serum TB-SA can effectively improve the sensitivity for the diagnosis of bacterial-negative pulmonary tuberculosis,which provides a determination method for the clinical diagnosis of bacterial-negative pulmonary tuberculosis,with high clinical application value.

关 键 词：支气管镜检查 结核分枝杆菌RNA 结核分枝杆菌特异性蛋白抗体 菌阴肺结核 诊断 

分 类 号：R378.91[医药卫生—病原生物学]