3种检测分枝杆菌方法的比较及应用价值分析

Comprison and Clinical Evalutiaon of Three Methods in Detection of Mycobacterium

目的:比较并评价涂片抗酸染色法(涂片法)、L-J培养法和基因芯片法在分枝杆菌检测中的应用价值。方法:对241例需查抗酸杆菌的临床标本,采用涂片法、L-J培养法和基因芯片法检测分枝杆菌,3种方法检测结果存在分歧的标本再进行DNA测序,以培养鉴定结果阳性或DNA测序得到分枝杆菌序列为确诊标准。结果:241例标本,涂片法、L-J培养法和基因芯片法的检测阳性率依次为18.7%、12.0%、15.8%,经卡方检验三者阳性率的差异没有统计学意义(P>0.05);检测灵敏度依次为85.4%、70.7%、93.0%,经卡方检验三种方法的灵敏度总体来说有差别(χ2=7.24,P<0.05),涂片法与L-J培养法以及涂片法与基因芯片法的灵敏度差异没有统计学差异,基因芯片法的灵敏度高于涂片法(χ2=6.61,P<0.05);检测特异性依次为95.6%、100.0%、100.0%。38例基因芯片检测阳性患者中有28例为结核分枝杆菌,10例为非结核分枝杆菌。结论:与涂片法及培养法相比较,基因芯片法能够鉴别分枝杆菌菌种,同时具有快速、可靠、准确度高的特点,在分枝杆菌感染的早期诊断和抗菌治疗上具有重要的临床价值。

Objective： To compare and evaluate the clinical application value of smear method, L-J culture and biochip system in detection of Mycobacterium. Methods： 241 of specimens from patients suspicious infected by My- cobacterium were tested by smear method, L-J culture and biochip system, and then compared to DNA sequencing if the results of three method were different, culture positive or DNA sequecing positive as diagnostic standard. Re- suits： The positive rates for the detection of Mycobacterium were 18.7%, 12.0%, 15.8%, by smear method, L-J cul- ture and biochip system, there was no significant difference among three methods. The sensitivity of detection of Mycobacterium by three methods were 85.4%,70.7%, 93.0%. There was a significant difference among three methods （χ2=7.24, P=0.03〈0.05）, and there was no significant difference between smear method and culture or biochip sys- tem, the sensitivity of biochip system was higher than cuhure（χ2=6.61, P=0.01〈0.05）. Their speificity were 95.0%, 100.0%, 100.0%. Conclusion： Compared with smear method and L-J culture, the biochip system provides a sim- ple, rapid, reliable, and highly accurate clinical assay for determination of mycobacterial species. So it has impor- tant clinical value in the early diagnosis of mycobacterial infection and antimicrobial therapy.