结核病临床诊治进展年度报告(2012年)(第一部分结核病临床诊断)

Annual report on clinical diagnosis and treatment progress of tuberculosis(2012)(Part 1 clinical diagnosis)

近一年来,国内外在结核病临床诊断方面取得了诸多进展,不少诊断新方法、新技术得以在临床上开展应用。在细菌学诊断方面,两种新技术包括等温微量热技术及爆轰纳米金刚石技术与传统的培养法相结合,提高了阳性检出率,具有速度快、敏感度和特异度高等优点。分子影像学在肺结核及肺外结核诊断中也取得了较大的进展。γ-干扰素释放试验在菌阴肺结核及肺外结核的诊断方面具有较大优势。2012年结核病分子生物学诊断仍集中在以核酸扩增为核心的检测技术上,而最引人注目的是Xpert Mtb/RIF技术,其在结核病和耐药结核病诊断中取得了丰硕的成果,在儿童结核病及Mtb与HIV双重感染的诊断方面也发挥了重要作用。RNA恒温扩增技术不仅可用于诊断结核病,还可用于疗效的监测。内镜介入诊断部分介绍了呼吸内镜在肺结核、气管支气管结核、纵隔淋巴结结核及胸膜结核诊断中的应用进展。其中支气管内镜超声引导下经支气管针吸活检术引起了国内外学者的极大关注,该方法以其操作技术简单、微创、定位准确、敏感度和特异度高,以及可重复性强等优势,在纵隔及肺门淋巴结结核的诊断中发挥了越来越大的作用。

In the recent 1 year,much progress has been made on the clinical diagnosis of tuberculosis（TB）,and some new diagnostic methods and techniques have already been employed in clinical practice.In the bacteriological diagnosis,the combination of 2new techniques isothermal microcalorimetry,detonation nanodiamonds with traditional culture is more rapid and could improve the detection rate,sensitivity and specificity.Molecular imaging in the diagnosis of pulmonary and extrapulmonary TB has made great progress.Interferon-gamma release assays have the superiority in the diagnosis of sputum-negative pulmonary TB and extrapulmonary TB.Molecular biology diagnosis for TB still focused on testing technology with a core of nucleic acid amplification.Among those methods,Xpert Mtb/RIF is most compelling,it not only achieved fruitful results in the diagnosis of TB and drug-resistant TB,but also played an important role in pediatric TB and Mtb/HIV coinfection.RNA simultaneous amplification and testing have been used for the diagnosis of TB and the surveillance of therapeutic effect.The episode for endoscopic intervention gave an introduction of its application in pulmonary TB,tracheal/bronchial TB,mediastinal lymph node TB and pleural TB.Endobronchial ultrasound-guided transbronchial needle aspiration（EBUS-TBNA） has drawn great attentions of scholars both at home and abroad.Being characterized by simple procedure,minimally invasive,accurate positioning with high sensitivity,specificity and repeatability,EBUS-TBNA has become more and more important in the diagnosis of mediastinal and hilar lymph node TB.