骨关节结核各类标本进行结核分枝杆菌培养与PCR检测的阳性率结果分析

Analysis of Various Osteoarticular Tuberculosis Specimen Types with Positive Mycobacterial Culture and Positive TB-PCR Results

目的比较骨关节结核病灶中脓液、干酪、肉芽及死骨组织的结核分枝杆菌培养阳性率，及结核分枝杆菌BACTECMGIT960（简称“MGIT960”）培养、改良罗氏培养基培养、PCR检测的联合阳性率。方法2011年6月至2012年5月首都医科大学附属北京胸科医院收治的经病理明确诊断为骨关节结核的患者50例，通过手术获取病灶中的脓液（50份）、干酪（42份）、肉芽（48份）及死骨组织标本（43份），分别进行结核分枝杆菌MGIT960培养及改良罗氏培养基培养，比较4种组织标本的培养阳性率，计算2种培养方法的联合阳性率；对脓液标本单独通过PCR方法进行了阳性率检测，计算脓液标本3种方法的联合阳性率。结果4种标本MGIT960培养的阳性率依次为：死骨组织（41．9％，18／43）〉脓液（40．0％，20／50）〉肉芽（33．370，16／48）=干酪（33．3％，14／42）;4种标本改良罗氏培养阳性率依次为：肉芽（20．8％，10／48）〉脓液（20．0％，10／50）〉死骨组织（16．3％，7／43）〉干酪（14．3％，6／42）;脓液的PCR检测阳性率为48．0％（24/50）。MGIT960和改良罗氏培养2种结核分枝杆菌培养方法的联合阳性率为50．0％（25／50），而PCR检测、MGIT960和改良罗氏培养3种方法的联合阳性率为68．0％（34／50）。结论骨关节结核患者，应尽可能选择多种标本以提高培养阳性率。MGIT960培养可以作为首选的细菌学诊断方法，但如果再联合使用改良罗氏培养和PCR扩增技术，能够进一步提高检出阳性率。

Objective To compare the positive culture rate in 4 specimen types, including abscess, caseation, granulation tissues and necrotic bone from osteoarticular tuberculosis patients and to analyze the combined positive rate of BACTEC MGIT 960 Mycobacterial Detection （MGIT 960）, Lowenstein-Jensen （L-J） culture and TB-PCR testing. Methods Fifty patients who diagnosed osteoarticular tuberculosis by pathological examination were admitted to Beijing Chest Hospital affiliated to Capital Medical University from June 2011 to May 2012. Specimens （50 cases of abscess, 42 cases of caseation, 48 cases of granulation and 43 cases of necrotic bone） were collected during surgery from those patients. All of the 4 specimen types were cultured by both MGIT 960 and L-J medium. The abscess specimen was also detected by PCR testing. Results The positive culture rates of abscess, caseation, granulation tissues and necrotic bone by MGIT 960 were 40.0% （20/50）, 33.3% （14/42）, 33.3% （16/48） and 41.9% （18/43） respectively, while which was 20.0% （10/50）, 14.3% （6/42）, 20.8% （10/48） and 16.3% （7/43） by L-J culture. The positive rate of abscess detected by PCR was 48.0% （24/50）. The positive rate combined with the two methods of Mycobacterium tuberculosis culture was 50.0% （25/50）, which was raised to 68.0% （34/50） when the PCR testing was also combined. Conclusion In order to increase the positive culture rate, a variety Of specimens should be selected from the osteoarticular tuberculosis patients. MGIT 960 culture can be used as the preferred method of bacteriological diagnosis. The positive rate of detection can be further enhanced by the combined utilization of MGIT 960, Lowenstein-Jensen medium and PCR testing.