改良结核分枝杆菌L型检测方法在结核病早期诊断中的价值

Clinical Value of Acid-fast Staining Method on Early Diagnosis of MTB-L

目的探讨改良结核分枝杆菌L型检测方法在结核病早期诊断中的应用价值。方法选择2012年8月至2014年8月在武汉市第十一医院门诊确诊的120例活动性肺结核患者,分别采用荧光定量聚合酶链反应法(PCR)、MTB-L抗酸染色法、萋-尼抗酸染色法(Ziehl-Nelsen,Z-N)、改良IK抗酸染色法检测MTB-L的阳性感染率,以荧光定量PCR法作为金标准,评价各种检测方法对MTB-L结核病的诊断价值。结果荧光定量PCR法MTB-L阳性检出率为30.0%(36/120),Z-N法阳性检出率为14.2%(17/120),改良IK抗酸染色法阳性检出率为25.8%(27/120),MTB-L抗酸染色法阳性检出率为28.3%(34/120)。以荧光定量PCR法作为金标准,MTB-L抗酸染色法检测特异度为96.4%,灵敏度为86.1%,准确度为93.3%;与荧光定量PCR法结果比较,Z-N法检测Kappa值为0.509,改良IK抗酸染色法Kappa值为0.731,MTB-L抗酸染色法Kappa值为0.839,MTB-L抗酸染色法与荧光定量PCR法一致性最好。结论 MTB-L抗酸染色法检测MTB-L的特异度、准确度较高,与荧光定量PCR法一致性最好,且操作简单,对MTB-L早期诊断具有重要的参考价值。

Objective To explore the clinical value of acid-fast staining method on early diagnosis of MTB-L. Methods A total of 120 active tuberculosis patients was selected in Wuhan Eleventh Hospital from Aug. 2012 to Aug. 2014 were included in the study, and fluorescence quantitative polymerase chain reaction （PCR） and MTB-L acid fast staining method, ZiehlNeelsen acid fast staining method （ Z-N method）, modi- fied IK acid fast staining method were used for detecting the MTB-L infection positive rate, with the fluorescent quantitative PCR method as the ＂gold standard＂ to evaluate the diagnostic value of different methods. Results The positive rate of fluorescent quantitative PCR method was 30.0% （36/120） , of Z-N method was 14.2% （17/120） ,of modified IK acid fast staining method was 25.8% （27/120） ,of MTB-L acid fast staining method was 28.3% （34/120）. Using fluorescence quantitative PCR method as the ＂ gold standard＂ , the specificity of MTB-L acid fast staining method was 96.4% , the sensitivity was 86. 1% ,the accuracy was 93.3%. Compared with fluorescence quantitative PCR method, the Kappa value of Z-N method was 0. 509,of IK modified acid fast staining method was 0. 731, of MTB-L acid-fast staining method was 0. 839. The consistency of MTB-L acid fast staining and fluorescence quantitative PCR method were best. Conclusion MTB-L acid-fast staining method for detection of MTB-L has high specificity and accuracy, and best consistency to fluorescence quantitative PCR method, which also has simple operation, and great referen- tial value for the early diagnosis of MTB-L.