痰涂片检查在结核病控制项目工作中的实验评价

Experimental evaluation of sputum smear detecting tubercle bacillus in controlling tuberculosis

目的评价痰涂片检查在世界银行贷款结核病控制项目中的作用。方法分别采用直接涂片抗酸染色法和经典改良罗氏培养基培养法对120例患者痰标本进行平行试验并比较结果。结果120例符合项目要求合格痰直接涂片抗酸染色法阳性率为30%（36/120）,并经省、市项目参比实验室复核证实,改良罗氏培养法阳性率为34.17%（41/120）。另对不符合项目质控要求的80例黏液唾液痰进行涂片检查和培养,结果直接抗酸涂片阳性率仅为1.25%（1/80）,改良罗氏培养法阳性率为3.75%（3/80）,均明显低于合乎项目质控要求的120例痰标本阳性率（P〈0.01）。结论用直接涂片抗酸染色法查痰出结果时间短、简便、费用低,只要痰标本质量符合项目要求,痰检质控好,并且镜检认真判读,就能最大限度地提高阳性率、减少排菌患者漏诊,反映出项目中痰涂片查菌是可信的。

Objective To evaluate the significance of sputum smear detecting tubercle bacillus in the project of World Bank loan for controlling tuberculosis. Methods Direct smear acid-fast staining method and classical reformative Lowenstein-Jensen culture media method were apllied in detecting 120 sputum samples from preliminary diagnostic patients. The results were compared. Results To 120 sputum specimens according with the requirement of the project, the positive rate was 30% （36/120） apllied with direct smear acid-fast staining method or 34.17% （41/120） apllied with classical reformative Lowenstein-Jensen culture media method. The results were confirmed through the check of the provincial and civic project laboratories. There were 80 mucous sputum specimens that didn＇t accord with the requirement of the project. The mucous sputum specimens positive rate was only 1. 25 （1/80） apllied with smear examination and culture or 3.75 % （3/80） apllied with classical reformative Lowenstein-Jensen culture media method, significantly lower than that of the 120 sputum specimens according with the requirement （P〈0.01）. Conclusion Direct smear acid-fast staining method is simple, rapid, and low-cost. As long as the quality of sputum specimen accord with the requirement of the project, and the quality control of sputum detection is well, we can increase the positive rate and reduce the missing diagnosis of dubious patients. It shows that screening tuberculosis with sputum smear is credible.