传统与现代方法联合检测在肺结核实验室诊断中的价值

Combined traditional and modern method detection in the diagnosis of TB laboratory value

目的探讨T-SPOT.TB、肺泡灌洗液(BALF)-TBDNA、BALF涂片、痰-TBDNA、痰涂片等传统与现代方法在诊断肺结核中的准确性以及联合检测优越性。方法回顾性调查,对120例患者均用上述五种方法检测,对各检测结果统计对比分析。结果 BALF-TBDNA、BALF涂片阳性率分别为72.1%、33.8%,明显高于痰TBDNA(阳性率51.5%)、痰涂片(阳性率17.6%),差异有统计学意义(P<0.05);血T-SPOT.TB敏感性为89.7%,特异性为92.3%,与BALF-TBDNA、BALF涂片三者联合检测敏感性为100.0%,阳性预测值为100.0%,阴性预测值为100%。与单项检测对比差异有统计学意义(P<0.05)。结论用BALF进行TBDNA和涂片检测明显优于痰标本;血T-SPOT.TB有较好的敏感度和特异度,与BALF-TBDNA、BALF涂片联合检测提高了肺结核的诊断阳性率,减少肺结核的误诊、漏诊,是一组值得推广的检测方法。

Objective To explored the accuracy of advantages of the T- spot TB test in blood,the DNA in BALF and BALF smear,the DNA in sputum and sputum smear in diagnosis of tuberculosis. Methods 120 cases suspected tuberculosis patients were analyzed in our hospital. All patients were detected by the five method,and analyzed.Results The positive rates of the DNA in BALF and BALF smear were 72. 1% and 33. 8%,respectively. They are significantly higher than the rate of the DNA in sputum（ positive rate 51. 5%） and sputum smear（ positive rate 17.6%）,the difference was statistically significant（ P〈0. 05）. The sensitivity and specificity of the T- spot TB test in blood were 89. 7% and 92. 3%,respectively. Combining detection the DNA in BALF and BALF smear,the sensitivity of them was 100. 0%. The positive predictive value was 100. 0%. The negative predictive value was100. 0%. It has the significant difference,comparing the single detection（ P〈0. 05）. Conclusion To detect the DNA and smear with BALF is obviously better than the sputum smear; The T- spot TB test in blood has higher sensitivity and specificity and higher value in diagnosis of tuberculosis. Combining detection the T- spot TB test in blood,the DNA in BALF and BALF smear,they can improve the positive rates in diagnosis of tuberculosis,reduce the erroneous diagnosis or missed diagnosis. They are worthy being generalized and application.