5种方法联合检测对菌阴肺结核诊断价值的研究

Studies on 5 kinds of methods combination for detection of smear and culture negative pulmonary tuberculosis

目的 探讨痰聚合酶链反应 (PCR)TB DNA检测、血清结核分支杆菌胞壁糖脂免疫球蛋白G(LAMIgG)、卡介菌免疫球蛋白G(PPDIgG)、结核特异性循环免疫复合物 (SCIC)与结核菌素 (PPD)0 1U皮试联合检测对菌阴肺结核的诊断价值。方法 以上述 5种检测方法用于初治菌阳肺结核 3 1例、健康对照 5 3例、非结核肺疾病 3 0例、初治菌阴肺结核 5 4例同步检测。血清免疫学检测用酶联免疫吸附试验 (ELISA)。对结果分组分析评价。结果 单项检测的敏感性、特异性依次为PCR 96 8% ,96 2 % ;LAMIgG 69 2 % ,98 1% ;PPDIgG 62 1% ,98 1% ;SCIC 3 2 0 % ,98 1% ;PPD 0 1U 5 3 8% ,98 1%。单项检测对菌阴肺结核的检出率相应为 4 1 7% ,2 8 9% ,4 4 4 % ,2 8 9,2 1 4 %。联合检测对菌阴肺结核的检出率 2、3、4、5联分别为 66 9% ,75 0 % ,80 4 % ,85 7%。均明显高于单项检测 ,并高于对菌阳组单项检测的阳性率。联合检测特异性随联合种类增多有轻微下降 ,最大下降幅度仅 9%。2、3、4种联合检测特异性仍保持在 90 %以上。结论 5种方法用于菌阴肺结核诊断 ,联合检测阳性检出率明显增加 ,而特异性仅稍降低。故联合检测用于菌阴肺结核诊断值得推广。

Objective To evaluate the diagnostic value of 5 kinds of methods used jointly for smear and culture negative pulmonary tuberculosis. Methods The high specificity methods were PCR examination for sputum TB DNA, immunological examination (ELISA method) for serum LAM IgG, PPD IgG, SCIC and PPD 0.1 U skin test. Smear and culture positive cases were 31, smear and culture negative 54, healthy control 53, other lung disease 30. Methods were used for every case synchronously, then the sensitivity and specificity of single method and the diagnostic value of single and joint examination for smear and culture negative patients were evaluated. Results In single examination sensitivity of PCR, LAM IgG, PPD IgG, SCIC, PPD 0 1 U was 96 8%, 69 2%, 62 1%, 32 0%, 53 8% respectively; specificity was 96 2%, 98 1%, 98 1%, 98 1% correspondingly. The positive detection rate of single examination for sputum TB negative patients was just 21 4%～ 44 4%. In combination examination the positive rates increased remarkblely by the number combined from 2 to 5, they were 66.9%, 70.5%, 80.4%, 85.7% respectively and they were more notable than that of TB positive group. The specificity of combination examination was slightly decreased by the number combined. It decreased just by 9% and the specificity of most examination methods kept on no less than 90%. Conclusions For diagnosis of smear and culture negative pulmonary tuberculosis combination examination using the high specificity methods can increase the sensitivity obviously and the specificity just decrease slightly. It is valuable for widely use of combination method in detection of smear and culture negative patients.