肺组织结核菌培养和结核分枝杆菌-DNA检测对菌阴肺结核患者的诊断价值  

Diagnostic Value of Pulmonary Tuberculosis Culture and Mycobacterium Tuberculosis DNA Detection in Patients with Negative Pulmonary Tuberculosis

作　　者：马杰[1] 林震宇 邓建宁[1] 吴金伟 Ma Jie;Lin Zhenyu;Deng Jianning;Wu Jinwei(Nanning Fourth People's Hospital,Nanning 530023,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]南宁市第四人民医院,广西壮族自治区南宁530023

出　　处：《中外医药研究》2023年第25期145-147,共3页JOURNAL OF CHINESE AND FOREIGN MEDICINE AND PHARMACY RESEARCH

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(编号:Z20180601)。

摘　　要：目的:探讨肺组织结核菌培养、结核分枝杆菌-DNA(TB-DNA)检测在菌阴肺结核诊断中的应用价值。方法:选取南宁市第四人民医院2015年9月—2020年1月收治的68例疑似菌阴肺结核患者作为研究对象,所有患者采用全胸腔镜或胸腔镜辅助小切口行肺切除术,将手术切除的肺病灶组织浸泡在福尔马林溶液中固定,取部分组织进行肺组织结核菌培养和TB-DNA检测,剩余肺病灶组织进行病理检查。同时对患者痰液样本进行痰涂片检查。以病理检查结果为金标准,比较单独采用肺组织结核菌培养、TB-DNA检测及二者联合检测对菌阴肺结核的诊断价值。结果:68例患者痰涂片及病理检查诊断结果显示,菌阴肺结核42例,肺部其他疾病26例。肺组织结核菌培养检出菌阴肺结核与痰涂片及病理检查诊断一致性较高(Kappa=0.646,P<0.05),TB-DNA检测检出菌阴肺结核与痰涂片及病理检查诊断中度一致(Kappa=0.529,P<0.05),肺组织结核菌培养联合TB-DNA检测检出菌阴肺结核与痰涂片及病理检查诊断一致性极好(Kappa=0.816,P<0.05)。肺组织结核菌培养联合TB-DNA检测诊断菌阴肺结核的敏感度、正确率高于肺组织结核菌培养、TB-DNA单独检测,漏诊率低于肺组织结核菌培养、TB-DNA单独检测,差异有统计学意义(P<0.05);肺组织结核菌培养联合TB-DNA检测诊断菌阴肺结核的特异性、阳性预测值、阴性预测值高于二者单独检测,误诊率低于二者单独检测,但差异无统计学意义(P>0.05)。结论:肺组织结核菌培养、TB-DNA检测均是诊断菌阴肺结核的有效指标,且与二者单独检测相比,联合检测的检出率、敏感度和特异性更高。Objective:To explore the diagnostic value of pulmonary tuberculosis culture and Mycobacterium tuberculosis DNA(TB-DNA)detection in bacterial negative pulmonary tuberculosis.Methods:Sixty-eight patients with suspected bacterial negative pulmonary tuberculosis admitted to Nanning Fourth People's Hospital from September 2015 to January 2020 were selected as the study objects.All patients underwent complete thoracoscopic or thoracoscopic assisted small-incision pulmonary resection.The excised lung tissue was soaked in formalin solution and fixed.Part of the lung tissue was taken for TB culture and TB-DNA detection,and the remaining lung tissue was pathologically examined.At the same time,sputum smear examination was performed on the patient's sputum samples.Using the pathological results as the gold standard,the diagnostic value of pulmonary tuberculosis culture,TB-DNA and combined detection was compared.Results:The results of sputum smear and pathological examination of 68 patients showed that there were 42 cases of bacterial negative pulmonary tuberculosis and 26 cases of other pulmonary diseases;There was a high consistency in the diagnosis of negative pulmonary tuberculosis detected by TB culture in lung tissue with sputum smear and pathological examination(Kappa=0.646,P<0.05),the detection of negative pulmonary tuberculosis by TB-DNA was consistent with the moderate diagnosis of sputum smear and pathological examination(Kappa=0.529,P<0.05),the results of pulmonary tuberculosis culture combined with TB-DNA detection showed good consistency with sputum smear and pathological examination(Kappa=0.816,P<0.05);The sensitivity and accuracy of pulmonary tuberculosis culture combined with TB-DNA detection were higher than that of pulmonary tuberculos is culture combined with TB-DNA detection,the rate of missed diagnosis was lower than that of TB culture in lungtissue and TB-DNA detection alone,and the difference was statistically significant(P<0.05);The specificity,positive predictive value and negative predictive value

关 键 词：菌阴肺结核 肺组织结核菌培养 结核分枝杆菌-DNA检测 

分 类 号：R52[医药卫生—内科学]