痰涂片阳性结核病患者的涂片与培养结果分析

Analysis of Smear and Culture Results of Sputum Smear Positive Tuberculosis Patients

目的探讨痰涂片阳性结核病患者不同时期标本涂片与罗氏培养阳性率的差异,剖析痰涂片与痰培养的标本选择标准。方法回顾性分析福建省福州市仓山区疾病预防控制中心2010年1月—2013年12月420例结核病痰涂片阳性患者的痰涂片和培养结果。比较即时痰、夜间痰和晨痰涂片与培养阳性率的差异。结果 3份痰涂片结果均为阳性患者273例(65%),仅2份为阳性者101例(24.05%),仅1份为阳性者46例(10.95%)。即时痰涂片结果为阳性患者315例(75%),即时痰涂片为阴性而夜间痰为阳性患者76例(18.09%),即时痰、夜间痰均为阴性而晨痰为阳性患者29例(6.91%);即时痰、夜间痰及晨痰涂片阳性例数分别为315例(75%)、370例(88.09%)、374例(89.05%),即时痰与夜间痰、晨痰阳性例数比较差异有统计学意义(χ2=23.069、27.161,P<0.01),夜间痰与晨痰阳性例数比较,差异无统计学意义(χ2=0.106,P>0.05)。404例共有5份痰培养污染,即时痰、夜间痰及晨痰标本污染率分别为0.24%(1例)、0.48%(2例)、0.48%(2例),组间比较差异无统计学意义(P>0.05);排除污染标本,即时痰培养阳性例数为391例(97.02%)、夜间痰阳性例数为376例(93.77%)、晨痰阳性例数为385例(96.49%),仅即时痰与夜间痰比较差异有统计学意义(χ2=4.142,P<0.05)。结论在检测过程中出现1份标本涂片阳性构成比过高,应对检测机构涂片质量进行检测和评估;如果基层疾控中心或医疗机构资源有限前提下,可按照痰涂片阳性标本优先培养原则,将2份痰培养标本改为1份。

Objective To investigate the difference of positive rate of sputum smear and culture in different periods of sputum smear positive tuberculosis patients, and to analyze the selection criteria of sputum smear and sputum culture.Methods？Retrospective analysis of sputum smear and culture results of 420 cases of tuberculosis sputum smear positive patients in Cangshan District, Fuzhou City, Fujian province from January 2010 to December 2013.Compare the difference of the positive rate of sputum smear and sputum smear and culture in the immediate sputum, night sputum and morning sputum smear. Results Sputum smear results were positive in 273 cases（65%）, only 2 were positive in 101 cases（24.05%）, only 1were positive in 46 cases（10.95%）. The immediate results for the 315 cases of sputum smear positive patients（75%）, instant sputum smear negative but at night for 76 cases of patients with positive sputum（18.09%）, sputum, sputum were negative at night and morning sputum of 29 cases of positive patients（6.91%）; night and morning sputum sputum, sputum smear positive cases respectively. 315 cases（75%）, 370 cases（88.09%）, 374 cases（89.05%）, sputum and night sputum and morning sputum positive cases comparison, the difference was statistically significant（χ2=23.069, 27.161, P〈0.01）, night sputum and morning sputum positive cases, the difference was statistically significant（χ2=0.106, P〉0.05）. A total of 404 cases of 5sputum culture pollution, sputum, sputum and night morning sputum pollution rate was 0.24%（1 cases）, 0.48%（2 cases）,0.48%（2 cases）, the difference was statistically significant（P〉0.05）; removing contaminated specimens, positive sputum culture for the number of cases 391 cases（97.02%）, night sputum positive for 376 cases（93.77%）, morning sputum positive for385 cases（96.49%）, only the sputum and night sputum with statistical difference（χ2=4.142, P〈0.05）.Conclusion In the detection process of 1 specimens of smear positive ratio is too high, the quality inspection to smear and assessment; if the grass-roots CDC or medical institutions under the premise of limited resources, in accordance with sputum smear positive specimens prior training principles, 2 sputum culture specimens changed to 1.