显微镜观察药物敏感度检测技术在肺外结核诊断中的应用

Application tuberculosis of microscopic observation drug susceptibility assay in diagnosis of extrapulmonary

目的探讨显微镜观察药物敏感度检测技术（MODS）对肺外结核的诊断价值。方法采用24孔细胞培养板液体培养方法建立MODS。收集74份结核性胸膜炎患者的胸腔积液、63份结核性脑膜炎患者的脑脊液和18份非结核病患者胸腔积液和脑脊液标本，分别采用抗酸染色法、改良罗氏培养法和MODs进行结核分枝杆菌检测，对改良罗氏培养法和MODS培养获得的分枝杆菌采用免疫层析法鉴定，数据比较采用y。检验。结果MODS、改良罗氏培养法和抗酸染色法检测结核性胸膜炎的阳性率分别为58．1％（43／74）、18．9％（14／74）和6．8％（5／74）；检测结核性脑膜炎的阳性率分别为54．0％（34／63）、20．6％（t3／63）和4．8％（3／63）。MODS检测结核性胸膜炎和结核性脑膜炎的阳性率均高于改良罗氏培养法，差异有统计学意义（X^2=24．00，P〈0．01；X^2=14．97，P〈0．01）。所有改良罗氏培养法和MODS检测获得的分枝杆菌均为结核分枝杆菌。三种方法检测18份非结核病患者胸腔积液和脑脊液结果均为阴性。MODS检测脑脊液和胸腔积液标本的阳性检出中位时间分别为9d和14d，明显短于改良罗氏培养法所需的31d。结论MODS与传统病原学检测方法相比，具有敏感性好、检出时间短的优势，适用于肺外结核病的临床快速诊断。

Objective To investigate the diagnostic value of microscopic observation drug susceptibility assay （MODS） in extrapulmonary tuberculosis. Methods MODS technology was constructed by using 24-well cell culture plate and liquid culture. Ziebl-Neelsen smear, LowensteinJensen culture and MODS were used to detect Mycobacterium tuberculosis in 74 pleural fluid samples collected from patients with tuberculous pleurisy, 63 cerebrospinal fluid samples collected from patients with tuberculous meningitis and 18 samples collected from non-tuberculosis suspects. The immunochromatography was used to distinguish Mycobacterium tuberculosis from nontuberculosis mycobacteria. The resuits of Ziehl-Neelsen smear, Lowenstein-Jensen culture and MODS were compared by X^2 test. Results The positive rates of MODS, Lowenstein-Jensen culture and Ziehl- Neelsen smear were 58.1%（43/74）, 18. 9% （14/74） and 6. 8% （5/74）, respectively in tuberculous pleurisy patients; 54.0%（34/63）, 20. 6% （13/63） and 4. 8% （3/63）, respectively in tuberculous meningitis patients. The positive rate of MODS technology was significantly higher than that of Lowenstein-Jensen culture in tuberculous pleurisy patients （X^2 = 24.00, P 〈 0.01） and tuberculous meningitis patients （X^2= 14. 97, P 〈 0. 01 ）. Each Mycobacterium obtained from MODS and Lowenstein-Jensen culture was identified as Mycobacterium tuberculosis by immunochrornatography. All of the 18 pleural fluid and cerebrospinal fluid samples which collected from non-tuberculosis suspects were all negative detected by Ziehl-Neelsen smear, Lowenstein-Jensen culture and MODS. The median time to culture positive of MODS was 9 days in cerebrospinal fluid and 14 days in pleural fluid samples, which were both significantly shorter than that of Lowenstein-Jensen culture （31 days in both cerebrospinal fluid and pleural fluid samples）. Conclusion Compared to conventional microbiological diagnosis methods, MODS is a rapid detection method of Mycobacterium tuberculosis with a higher positive detection rate, which is suitable for rapid diagnosis of extrapulmonary tuberculosis.