结核性胸膜炎诊断方法在临床应用中的对比研究

Comparison of the diagnostic methods of tuberculosis pleurisy in clinical application

目的探讨结核性胸膜炎的病理学检查、影像学(CT)特征及试验检测指标特点,以达到早诊断、早治疗的目的。方法选取该院2014年7月至2015年12月收治的86例结核性胸膜炎患者作为试验组,80例非结核性胸膜炎患者作为对照组,均行胸腔积液腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、结核杆菌DNA(TB-DNA)、抗酸染色,同时联合结核感染T细胞斑点试验(T-SPOT.TB)和影像学检查,并与病理学检查进行对比分析,比较各种检查方法的应用价值。结果 86例结核性胸膜炎患者中,ADA、TB-DNA、抗酸染色、T-SPOT.TB和影像学检查的灵敏度分别为53.48%(46/86)、6.98%(6/86)、11.62%(10/86)、84.88%(73/86)、37.21%(32/86),特异度分别为95.00%(76/80)、100.00%(80/80)、100.00%(80/80)、61.25%(49/80)、98.75%(79/80)。ADA、TB-DNA、T-SPOT.TB和影像学检查与病理检查的符合度分别为83.02%(44/53)、11.32%(6/53)、88.68%(47/53)、60.38%(32/53)。结论影像学和试验检测指标上的差异,对于结核性胸膜炎的的临床诊断具有一定的指导意义,临床上除常规检查外,应尽可能完善其他检查,进行综合分析以提高诊断准确性。

Objective To investigate pathological examination,imaging features and test indexes of tuberculous pleurisy and achieve early diagnosis and treatment purpose.Methods A total of 86 cases of tuberculous pleurisy patients in our hospital from July2014 to December 2015 were chosen as the experimental group,80 cases of non tuberculous patients as control group.All patients underwent adenosine deamlnase（ADA）,lactate dehydrogenase（LDH）,Mycobacterium tuberculosis DNA（TB-DNA）,acid fast staining,combined with tuberculosis infection T cell spot test（T-SPOT.TB）and imaging examination,and pathological examination were analyzed,and the application value of all kinds of inspection methods were compared.Results The 86 cases of patients with tuberculous pleurisy,sensitivity of ADA,TB-DNA,T-SPOT.TB,acid fast staining and imaging examination were 53.48%（46/86）,6.98%（6/86）,11.62%（10/86）,84.88%（73/86）,37.21%（32/86）;the specificity were 95.00%（76/80）,100.00%（80/80）,100.00%（80/80）,61.25%（49/80）,and 98.75%（79/80）,respectively.The coincidence rates of ADA,TB-DNA,T-SPOT.TB and imaging examination and pathological examination were 83.02%（44/53）,11.32%（6/53）,88.68%（32/53）,and 60.38%（47/53）,respectively.Conclusion The difference of imaging and testing index,have certain guiding significance for the clinical diagnosis of tuberculous pleurisy.In addition to routine clinical examination,the method should as far as possible to improve other checks,comprehensive analysis to improve the diagnostic accuracy.