体液涂片抗酸染色在先天性结核病早期诊断中的价值

The value of acid-fast stain test of body fluid smears in the early diagnosis of congenital tuberculosis

目的探讨先天性结核病早期诊断的方法.方法回顾性分析重庆医科大学附属儿童医院1984年4月～2003年4月收治的9例先天性结核病患儿及国内报道的先天性结核病54例临床资料.结果先天性结核病死率为60.3%(38/63),生前确诊率为60.3%(38/63),母亲有结核病占74.6%(47/63).体液涂片、胸片、培养、OT试验、结核抗体检测、PCR检测、PPD试验阳性率分别为80%(16/20)、56.6%(29/53)、60%(6/10)、8.33%(1/12)、44.4%(4/9)、57.1%(4/7)、33.3%(1/3),体液涂片阳性率与胸片、OT试验阳性率相比P<0.05,与其他方法相比,因其他方法样本量较小,P>0.05.结论体液涂片抗酸染色检查阳性率高于胸片、OT试验阳性率,涂片检查简便、快捷,为早期诊断先天性结核最有效方法,应广泛应用.

Objective To explore the assay of early diagnosing congenital tuberculosis. Methods Nine newborn infants with congenital tuberculosis from April 1984 to April 2003 in children＇s hospital affiliated Chongqing University of Medical Sciences and the clinical data of 54 cases with congenital tuberculosis reported in domestic literatures were analyzed retrospectively. Results The mortality of congenital tuberculosis was 60.3 % （38/63）, the correct diagnosis rate of congenital tuberculosis before death was 60. 3 % （38/63）, 74.6 % （47/63）of infants＇ mothers had tuberculosis history, the positive rates of body fluid smears to detect acid-fast bacilli, chest x-ray,culture of tuberde bacillus, old tuberculin test （OT）, tuberculous antibody test, PCR , purified protein derivative of the tuberculin （PPD）assay were 80% （16/20） ,56. 6%（29/53） ,60%（6/10）, 8.33%（1/12）, 44.4%（4/9）, 57. 1%（4/7） and 33.3 % （1/3）respectively , the positive rate of acid-fast stain test were compared with chest x-ray and old tuberculin test assay , P〈0.05,while compared with other 4 items ,there was no significant difference, P〉0. 05. Conclusion The positive rate of acidfast stain test was higher than chest x-ray and old tuberculin test assay. Because the samples of other methods were small, the significant difference between acid-fast stain test and other examinations was not found. Smears of body fluid to detect acid-fast bacilli is the most efficacious assay in the early diagnosis of congenital tuberculosis, which should be used widely in clinic.