基于痰标本的快速筛查方法在初诊疑似肺结核患者诊断中的临床应用  

Clinical application of rapid screening method based on sputum specimens in the diagnosis of patients with suspected pulmonary tuberculosis at first diagnosis

作　　者：周游 何希 黄丽花 刘爱梅 眭文娴 胡敏 杨小兵 ZHOU You;HE Xi;HUANG Lihua;LIU Aimei;SUI Wenxian;HU Min;YANG Xiaobing(Science and Education Biological Sample Library,Chest Hospital of Guangxi Zhuang Autonomous Region,Liuzhou 545005,Guangxi,China;Department of Thoracic and Cardiac Surgery,Chest Hospital of Guangxi Zhuang Autonomous Region,Liuzhou 545005,Guangxi,China;Department of Medical Laboratory,Chest Hospital of Guangxi Zhuang Autonomous Region,Liuzhou 545005,Guangxi,China;Office of President,Chest Hospital of Guangxi Zhuang Autonomous Region,Liuzhou 545005,Guangxi,China)

机构地区：[1]广西壮族自治区胸科医院科教科生物样本库,广西柳州545005 [2]广西壮族自治区胸科医院胸心外科,广西柳州545005 [3]广西壮族自治区胸科医院医学检验科,广西柳州545005 [4]广西壮族自治区胸科医院院长办公室,广西柳州545005

出　　处：《右江医学》2024年第9期834-839,共6页Chinese Youjiang Medical Journal

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2021031);广西科技重大专项(桂科AA22096027)。

摘　　要：目的探讨基于痰标本的快速筛查方法在初诊疑似肺结核患者诊断中的临床应用。方法选取2020年1月—2021年9月来广西胸科医院就诊的初诊疑似肺结核患者936例,收集所有患者痰标本分别进行痰涂片、固体培养和恒温扩增荧光法(简称“恒温扩增法”)检测,经筛选排除得到符合条件的病例共880例。对恒温扩增法、涂片和固体培养的灵敏度、特异性进行比较;使用Kappa检验评估痰涂片镜检、固体培养和恒温扩增法的一致性。结果恒温扩增法的灵敏度(40.27%)高于涂片(32.74%)和固体培养(35.10%),差异有统计学意义(P<0.05);恒温扩增法的特异性(99.50%)略高于涂片和固体培养(98.02%,99.01%),但差异无统计学意义(P>0.05)。恒温扩增法与涂片结果总体一致率为89.32%(786/880),与固体培养结果总体一致率为81.36%(716/880)。Kappa检验一致性分析结果显示恒温扩增法与涂片结果高度一致(Kappa值=0.738,P<0.001),与固体培养比较一致性中等(Kappa值=0.550,P<0.001)。结论恒温扩增法用于初诊疑似肺结核患者诊断有着较高的灵敏度和特异性,与涂片法的结果一致性较好,具有快速检测、诊断的优势,可以在基层医院广泛推广应用。Objective To explore the clinical application of rapid screening method based on sputum specimens in the diagnosis of newly diagnosed patients with suspected pulmonary tuberculosis.Methods A total of 936 newly diagnosed patients who visited Chest Hospital of Guangxi Zhuang Autonomous Region from January 2020 to September 2021 were selected.Sputum samples of all patients were collected and detected by sputum smear,solid culture and thermostatic amplification fluorescence(hereinafter referred to as"thermostatic amplification").After screening and exclusion,a total of 880 eligible cases were identified.The sensitivity and specificity of isothermal amplification,smear and solid culture were compared and analyzed.Kappa test was used to evaluate the consistency of sputum smear microscopy,solid culture and thermostatic amplification.Results The sensitivity of thermostatic amplification(40.27%)was higher than that of smear(32.74%)and solid culture(35.10%),and difference was statistically significant(P<0.05).The specificity of thermostatic amplification(99.50%)was slightly higher than that of smear(98.02%)and solid culture(99.01%),but difference was not statistically significant(P>0.05).The overall agreement rate of thermostatic amplification with smear results was 89.32%(786/880),and that of thermostatic amplification with solid culture results was 81.36%(716/880).The consistency analysis of Kappa test showed that the thermostatic amplification method was highly consistent with the smear results(Kappa value=0.738,P<0.001),and the results showed moderate consistency with solid culture(Kappa=0.550,P<0.001).Conclusion Thermostatic amplification method has high sensitivity and specificity in the diagnosis of newly diagnosed patients with suspected pulmonary tuberculosis,and has good consistency with the results of smear method.It has the advantages of rapid detection and diagnosis,and can be widely applied in primary hospitals.

关 键 词：恒温扩增法 涂片 固体培养 肺结核 Kappa分析 维恩图 

分 类 号：R521[医药卫生—内科学]