五种检测方法在结核病诊断中的应用评价

Application and evaluation of 5 kinds of detection methods in diagnosis of tuberculosis

目的评估涂片抗酸染色法、改良罗氏培养基培养法、XPert MTB/RIF法、结核分枝杆菌RNA荧光定量PCR法、结核分枝杆菌DNA荧光定量PCR法在结核病诊断中的应用价值。方法对374例疑似肺结核病患者、120例肺结核患者及70例非结核病患者的痰液标本分别用涂片抗酸染色法、改良罗氏培养基培养法、XPert MTB/RIF、TB-RNAPCR、TB-DNA PCR进行结核分枝杆菌检测,将检测结果进行分析和比较。结果涂片抗酸染色法、改良罗氏培养基培养法、XPert MTB/RIF、TB-RNA PCR、TB-DNA PCR检测374例疑似肺结核病患者痰液标本阳性率分别为6.68%、13.37%、20.05%、19.25%、22.73%,其中XPert MTB/RIF、TB-RNA PCR、TB-DNA PCR检测阳性率差异无统计学意义(χ2=1.51,P>0.05),TB-RNA PCR阳性率高于改良罗氏培养基培养法(χ2=4.75,P<0.05),改良罗氏培养基培养法高于涂片抗酸染色法(χ2=9.28,P<0.05)。五种方法检测120例肺结核患者及70例非结核病患者的敏感性分别为20.83%、35.00%、50.83%、47.50%、54.17%,特异性分别为100.00%、100.00%、98.57%、100.00%、98.57%。结论 XPert MTB/RIF、TB-RNA PCR、TB-DNA PCR与涂片抗酸染色法、改良罗氏培养基培养法相比,具有敏感、快速、可定量的特点,可以作为结核病辅助诊断的有效检测方法。

Objective To evaluate the value of smear acid fast staining, modified Lowenstein-Jensen medium culture,Xpert Mycobacterium tuberculosis DNA and resistance to rifampicin（MTB/RIF）, MT RNA fluorescence quantitative PCR（TB-RNA PCR）, and MT DNA fluorescence quantitative PCR（TB-DNA PCR） in the diagnosis of tubercuosis（TB）. Methods Atotal of 564 sputum specimens from 374 pulmonary TB suspects, 120 pulmonary TB patients and 70 non-TB patients weredetected for MT bacteria by above-mentioned 5 detection methods respectively. The results of detection were analyzed andcompared. Results The MT positive rates of these methods were 6.68%, 13.37%, 20.05%, 19.25% and 22.73%,correspondingly in the 374 cases of TB suspected patients. There was no statistical differences in the rates among Xpert MTB/RIF, TB-RNA PCR and TB-DNA PCR（χ^2=1.51, P〈0.05）, but that of TB-RNA PCR was obviously higher than the results bythe modified Lowenstein- Jensen medium culture（χ^2=4.75, P〈0.05）, and so was that of the modified Lowenstein- Jensenmedium culture than the results of the smear acid fast staining（χ^2=9.28, P〈0.05）. The sensitivities of the 5 methods were20.83%, 35.00%, 50.83%, 47.50% and 54.17% respectively, while the specificities were 100.00%, 100.00%, 98.57%,100.00% and 98.57% in the 120 TB patients and 70 non- TB patients. Conclusion Compared with the smear acid faststaining and modified Lowenstein-Jensen medium culture, Xpert MTB/RIF, TB RNA PCR and TB DNA PCR are characterizedby rapidness, sensitivity and quantitativeness, and can be used as the effective detection method for auxiliary diagnosis of TB.