结节病和菌阴性结核病鉴别诊断新方法的临床评价

Evaluation of new methods for differentiating the diagnosis of sarcoidosis and smear/culture-negative tuberculosis

目的:验证和评价实时荧光定量PCR检测结核分枝杆菌DNA(TB-PCR)和临床-病理-影像综合评分系统在结节病与菌阴性结核病鉴别诊断中的应用价值。方法:采用TB-PCR检测和临床-病理-影像综合评分,分析鉴别病理活检报告为"结节病或增殖性结核病"的91例患者,并通过随访验证诊断准确率,评价2种鉴别诊断方法的临床应用价值。结果:①TB-PCR检测结果,91例患者中77例结核分枝杆菌DNA为阴性,14例阳性,阳性率为15.4%。而这77例TB-PCR检测结果为阴性的患者中,随访后仍维持诊断为结节病者74例,结核病2例,无法确定诊断者1例;14例TB-PCR检测结果为阳性的患者中,随访后仍维持诊断结核病3例,结节病8例,无法确定诊断3例。TB-PCR检测结果与随访后诊断一致的病例共77例(结核病3例、结节病74例),诊断明确率为84.6%(77/91),而诊断结节病的准确率达93.9%(77/82)。②临床-病理-影像综合评分结果,91例患者中经评分诊断为结节病者80例,诊断为结核病者11例。80例评分诊断为结节病的患者中,随访后仍维持结节病诊断者75例,结核病1例,无法确定诊断者4例。在11例评分诊断为结核病的患者中,随访后诊断仍维持结核病诊断者4例,结节病7例。评分结果与随访后诊断一致的病例共79例(结核病4例、结节病75例),诊断明确率为86.8%(79/91),诊断结节病的准确率达97.56%(80/82)。结论:TB-PCR检测和临床-病理-影像综合评分系统对于结节病与菌阴性结核病间的鉴别诊断均具有较高的诊断明确率和准确率。

Objective To verify and evaluate the real-time quantitative PCR to detect Mycobacterium tuberculosis DNA （TB-PCR） and the clinical-pathological-imaging scoring system for differentiating the diagnosis of sarcoidosis and smear/culture negative tuberculosis. Methods Ninety-one patients with proliferating granulomatosis could not be definitely diagnosed as sareoidosis or tuberculosis were enrolled in this study. Real-time quantitative PCR detecting Mycobacterium tuberculosis DNA and clinical-pathological-imaging scoring system were used for differentiating sareoidosis and tuberculosis. These two methods were assessed by follow up concordance analysis. Results ①Analyzed by TB-PCR： 77 samples were negative and 14 were positive （the positive rate was 15.4%）, When compared with the follow-up result, 74 of the 77 TB-PCR negative patients were diagnosed as sarcoidosis, 2 were diagnosed as tuberculosis, 1 was unable to confirm the diagnosis. Of the 14 TB-PCR positive patients, 3 were diagnosed as tuberculosis, 8 were diagnosed as sareoidosis, and 3 were unable to confirm the diagnosis. The percentage of definite diagnosis was 84.6% （77/91）, and the diagnostic accuracy rate for sarcoidosis is 93.9% （77/82）. ②Analyzed by the clinical-pathological-imaging scoring system, 80 of 91 samples were diagnosed as sarcoidosis and 11 were diagnosed as tuberculosis. When compared with the follow-up result, 75 of the 80 diagnosed by the scoring system as sarcoidosis were diagnosed again as sarcoidosis, 1 was diagnosed as tuberculosis, 4 were unable to confirm the diagnosis. Of thel 1 diagnosed as tuberculosis by the scoring system,4 were diagnosed as tuberculosis, 7 were diagnosed as sarcoidosis. The percentage of definite diagnosis was 86.8% （79/91）, and the diagnostic accuracy rate for sarcoidosis was 97.56% （80/82）. Conclusions These two methods can help the diagnosis and differentiating the diagnosis of sarcoidosis from smear/culture-negative tuberculosis in clinical practice.