夹层杯集菌离心涂片法与改良罗氏培养法检测抗酸杆菌的比较

Comparison of sandwich cup collecting bacteria and smear method and improved Lowenstein Jensen culture in detecting acid-fast bacilli

目的评价夹层杯集菌离心涂片法（夹层杯法）检测抗酸杆菌的临床诊断价值。方法收集2008年7—12月就诊于湖南省湘潭、湘乡、邵东和耒阳4个县（市）结核病防治部门共1190例肺结核可疑症状者的1782份痰标本（晨痰642份，即时痰1140份），每份标本同时采用夹层杯法与改良罗氏培养法（培养法）平行处理，对其检测结果进行比较。结果对晨痰标本检测的阳性率，培养法为26．64％（171／642），高于夹层杯法的阳性率23．52%（151／642），两者差异有显著性（Х^2=4．56，P=0．04）；对即时痰标本检测的阳性率，培养法为23．33％（266／1140），高于夹层杯法的阳性率18．07％（206／1140），两者差异有高度显著性（Х^2=34．60，P=0．00）。夹层杯法对晨痰的阳性检出率高于即时痰（Х^2=7．62，P=0．01）；培养法对晨痰的阳性检出率与即时痰比较，差异无显著性（Х^2=2．42，P=0．12）。结论夹层杯法检测抗酸杆菌的阳性率低于培养法，但简单、省时，便于进行质量控制，是一种很有推广价值的检测方法；夹层杯法检测晨痰抗酸杆菌的阳性率较高，故应尽量留取晨痰作抗酸杆菌检测。

Objective To investigate the clinical diagnostic value of sandwich cup collecting bacteria and smear method （sandwich cup method） in the detection of acid-fast bacilli. Methods From July to December 2008 , 1 782 sputum samples （including 642 morning sputum and 1 140 random sputum） were collected from people who were suspected to have pulmonary tuberculosis at tuberculosis prevention and treatment departments in 4 counties （cities） of Hunan Province. Each sample was dealt with sandwich cup method and improved Lowenstein Jensen（L-J） culture, respectively, the results were analyzed. Results The positive rate of L-J culture and sandwich cup method was 26. 64%（171/642） and 23. 52% （151/642） in morning sputum, respectively, there was significant difference between the two（Х^2= 4. 56,P= 0. 04）; The positive rate of L-J culture and sandwich cup method was 23.33%（266/ 1 140） and 18.07% （206/1 140） in random sputum respectively , there was significant difference between the two （Х^2 = 34. 60,P = 0. 00）. The positive rate of sandwich cup method in morning sputum was significantly higher than that in random sputum（Х^2 = 7. 62, P = 0. 01 ）, while the positive rate of L-J culture in morning and random sputum showed no statistical difference （Х^2 = 2. 42, P = 0. 12）. Conclusion The positive rate of sandwich cup method is lower than I.-J culture in detecting acid-fast bacilli, but the former is simple, time-saving and easy to carry out quality control, and is worth popularizing in clinic. The positive rate of sandwich cup method in morning sputum is high, so morning sputum should be kept to detect acid-fast bacilli clinically.