4种检测方法对骨结核的诊断价值比较  

Comparison of Four Methods in the Diagnosis of Bone Tuberculosis

作　　者：李晓琴 马志强 田楠 陈薇 李才信 周敏 Xiaoqin LI;Zhiqiang MA;Nan TIAN;Wei CHEN;Caixin LI;Min ZHOU(Dept.of Laboratory Infectious Disease,The Third People’s Hospital of Kunming,Yunnan Clinical Medical Center for Infectious Diseases,Kunming Yunnan 650031;School of Public Health,Kunming Medical University,Kunming Yunnan 650500,China)

机构地区：[1]昆明市第三人民医院检验科/云南省传染性疾病临床医学中心,云南昆明650031 [2]昆明医科大学公共卫生学院,云南昆明650500

出　　处：《昆明医科大学学报》2024年第2期131-135,共5页Journal of Kunming Medical University

基　　金：昆明市卫生科技人才培养项目[2022-SW(后备)-85]。

摘　　要：目的探讨涂片抗酸染色、TB-DNA、Xpert MTB/RIF、结核菌培养等4种检测方法对骨结核诊断的价值对比。方法对骨外科1 a内住院骨质破坏患者的病灶周围脓液,用4种检测方法进行检测,并对结果进行统计分析,指标包括:灵敏度、特异度、阳性预测值、阴性预测值。结果研究对象中以临床诊断为金标准,脓液涂片查抗酸杆菌灵敏度为31.75%,特异度为100.00%,阳性预测值100.00%,阴性预测值53.74%,约登指数为0.32;TB-DNA灵敏度为88.89%,特异度为98.00%,阳性预测值98.25%,阴性预测值87.50%,约登指数为0.87;Xpert MTB/RIF灵敏度为95.23%,特异度为68.00%,阳性预测值78.95%,阴性预测值91.90%,约登指数为0.63;脓液结核菌培养灵敏度为41.27%,特异度为100.00%,阳性预测值100.00%,阴性预测值57.47%,约登指数为0.41,(χ^(2)=77.354,P<0.005)4种检测方法差异具有统计学意义。结论4种检测方法中,TB-DNA灵敏度和特异度较好,Xpert MTB/RIF灵敏度较好,TB-DNA和Xpert MTB/RIF的真实性较好,同时阳性预测值和阴性预测值较高,对骨结核的诊断具有较好的价值。Objective To compare the diagnostic value of smear acid-fast staining,TB-DNA,X-pert MTB/RIF and culture of Mycobacterium tuberculosis.Methods Four methods were used to detect the perifocal pus of the patients with bone destruction in orthopaedics department within one year,and the results were analyzed statistically,the indexes included sensitivity,specificity,positive predictive value and negative predictive value.Results The sensitivity,specificity,positive predictive value,negative predictive value,and Youden index were 31.75%,100.00%,100.00%,53.74%and 0.32 respectively.TB-DNA had a sensitivity of 88.89%,a specificity of 98.00%,a positive predictive value of 98.25%,a negative predictive value of 87.50%,and a Youden Index of 0.87.Xpert MTB/Rif had a sensitivity of 95.23%,a specificity of 68.00%,and a positive predictive value of 78.95%,the negative predictive value was 91.90%,the Youden index was 0.63.The sensitivity,the specificity,the positive predictive value,the negative predictive value and the Youden index were 41.27%,100.00%,100.00%,57.47%and 0.41 respectively,(χ^(2)=77.354,P<0.005).Conclusion Among the four methods,TB-DNA has a good Sensitivity and specificity,Xpert mtbrif has a good sensitivity,TB-DNA and Xpert mtbrif ha a good authenticity,and both positive and negative predictive values are high,it has good value in the diagnosis of bone tuberculosis.

关 键 词：涂片抗酸染色 结核分枝杆菌基因 结核分枝杆菌及利福平耐药检测 结核菌培养 骨结核 

分 类 号：R529.2[医药卫生—内科学]