结核分枝杆菌核酸检测在矽肺结核患者中的应用价值

Application of Mycobacterium tuberculosis nucleic acid detection in silicotuberculosis patients

目的评价核酸检测法在矽肺结核患者中的临床应用价值。方法选取2015年112月在北京京煤集团总医院尘肺与结核病科住院的165例诊断为矽肺结核患者作为病例组；以同时期住院的90例矽肺患者作为对照组。留取研究对象痰标本用于检测。分别应用痰涂片显微镜检法、固体培养法和核酸检测法对研究对象的痰液标本进行检测，并对检测结果进行比较。结果以固体培养检测结果作为标准，核酸检测法检测病例组的敏感度为94．7％（36／38），特异度为81．1％（103／127），阳性预测值为60．0％（36／60），阴性预测值为98．1％（103／105）；以痰涂片法为标准，核酸检测法检测病例组的阳性预测值为55．0％（33／60），阴性预测值为i00．0Voo（105／105），敏感度为100．0％（33／33），特异度为79．5％（105／132）。与固体培养法和痰涂片法为标准，核酸检测法检测对照组的特异度均为96．7％（87／90）。病例组中，核酸检测法检测阳性率为36．4％（60／165），高于固体培养法的23．O％（38／165）和痰涂片法的20．O％（33／165），差异有统计学意义（X2=12．85，P〈0．05）；对照组中，核酸检测法检测阳性率为3．3％（3／90），其他方法检测阳性率为0．0％。结论在矽肺结核患者中，核酸检测对Mtb有较高的敏感度和特异度，对Mtb快速检测及辅助诊断具有较高的临床应用价值。

Objective To evaluate the clinical application of nucleic acid detection in silicotuberculosis patients. Methods 165 patients, who were diagnosed as silicosis tuberculosis in the department of Pneumoconiosis Tuberculosis, General Hospital of Jingmei Group between January to December in 2015, were selected as case group. 90 silicosis patients detected in the same period of time were selected as control group. Sputum smear microscopy, solid culture method and nucleic acid detection method were used to detect Mycobacterium in patient sputum samples and the results were compared. Results Using the results of solid culture test as golden standard, the sensitivity of nucleic acid detection was 94.7% （36/38） ~ specificity was 81.1% （103/127） ; positive predictive value was 60. 0% （36/60） and negative predictive value was 98. 1% （103/105） in the case group. With sputum smear method as standard, the nucleic acid detection got the results of positive predictive value.. 55.0% （33/60）, negative predictive value. 100% （105/105）, sensitivity.. 100% （33/33） and specificity： 79.5% （105/132）. Combining solid culture method and sputum smear method as standard, the specificity of nucleic acid detection in the control group was 96.7% （87/90）. In the case group, the positive rate of nucleic acid detection method was 36.4% （60/165）, which was significantly （Z2= 12.85, P〈0.05） higher than solid culture method of 23.0% （38/165）and sputum smear method of 20. 0% （33/165）. In the control group, the positive rate of nucleic acid detection method was 3.3% （3/90）, compared with the other methods with positive rates of 0. Conclusion In patients with tuberculo- silicosis, nucleic acid detection has high sensitivity and specificity to Mtb. It is a valuable method in clinical Mtb rapid detection and assist diagnosis.