尘肺结核相关实验室检查方法对比分析

Comparative analysis of laboratory test methods for pneumoconiosis tuberculosis

目的对比临床常用的尘肺结核相关实验室检查方法,为提高诊断效率提供科学依据。方法收集某煤炭集团总医院结核病科2013年4月-2015年4月住院治疗的尘肺病例200例。以病原学检查和治疗试验为金标准,将病原学检查阳性或治疗试验阳性的尘肺患者作为病例组(100例);将病原学检查阴性或治疗试验阴性的尘肺患者作为对照组(100例)。对收集的数据进行统计学处理,因素分析采用t检验或χ~2检验,计算各指标的灵敏度、特异度、约登指数、kappa值,采用ROC曲线进行比较。结果 C反应蛋白诊断尘肺结核的效率最佳,其最佳临界值(cutoff值)为6.5mg/L,灵敏度为71%,特异度为85%,约登指数(YI)为0.56,ROC曲线的曲线下面积(AUC)为0.801;γ-干扰素释放试验灵敏度为86%,特异度为53%,YI为0.39,AUC=0.695;ASSURE TB Rapid灵敏度为48%,特异度为89%,YI为0.37,AUC=0.685;24h集菌试验灵敏度为27%,特异度为100%,YI为0.27,AUC=0.635;痰涂片检查灵敏度为24%,特异度为100%,YI为0.24,AUC=0.620;罗氏痰培养与BACTEC快速痰培养相同,灵敏度为19%,特异度为100%,YI为0.19,AUC=0.595;SD Rapid TB灵敏度为20%,特异度为98%,YI为0.18,AUC=0.590;TB-CHECK-1灵敏度为17%,特异度为98%,YI为0.15,AUC=0.575。结论作为结核诊断的金标准,细菌学检查指标特异度均可以达到100%,但其中灵敏度最高的24h集菌试验灵敏度也只有27%。现有诊断方法单独使用时,C反应蛋白的诊断效率明显高于其他方法。对于尘肺结核的确切诊断现有的检查方法,其灵敏度、特异度依然有限,临床仍然迫切需求诊断效率更高的检查方法来对尘肺结核确诊。

Objective To provide a scientific basis for improving the diagnostic efficiency of the laboratory examination method of the clinical commonly used pneumoconiosis tuberculosis.Methods 200 cases of pneumoconiosis（all in the group under the mine）in tuberculosis department of a coal Group general hospital were collected in April 2013 to April 2015.Based on the gold standard on pathogenic examination and treatment test,the patients of pneumoconiosis with positive pathogen or positive treatment test were defined as the case group（100cases）.The patients with negative pathogen or negative treatment test were used as non tuberculosis group（100 cases）.The collected data were analyzed by factor analysis（i.e.between group comparison using t-test or chi square test）.The index of sensitivity,specificity,Youden index,and kappa value were calculated then were compared using ROC curve.Results The efficiency of C-reactive protein in diagnosis of pneumoconiosis combined with tuberculosis was the best.The best cutoff value was 6.5mg/L,sensitivity was 71%,specificity was 85%,Youden index（Yi）was 0.56,area under the ROC curve（AUC）was 0.801;The IFN-γ＇s sensitivity was 86%,specificity was 53%,YI was 0.39,AUC=0.695.The ASSURE TB Rapid＇s sensitivity was 48%,specificity was 89%,YI was 0.37,AUC=0.685.The sensitivity and specificity of the 24-hour collecting test were 100%,the specificity was 0.27,YI was 0.27,AUC=0.635.The Sputum smear＇s sensitivity was 24%,specificity was 100%,YI was 0.24,AUC=0.620.The same of Roche sputum culture and BACTEC rapid sputum culture was found.Sensitivity was 19%,specificity was 100%,YI was 0.19,AUC=0.595.The SD Rapid TB＇s sensitivity was 20%,specificity was98%,YI was 0.18,AUC=0.590.TB-CHECK-1sensitivity was 17%,specificity was 98%,YI was0.15,AUC=0.575.Conclusions Although the diagnosis of tuberculosis was the gold standard and specificity of bacteriological index can reach 100%,the highest sensitivity of 24 hset sensitivity of bacteria test was only 27%.The diagnostic efficiency of C reactive protein was significantly higher than that of other methods.As the sensitivity and specificity of the current diagnostic methods for the diagnosis of pneumoconiosis tuberculosis are still limited,the diagnostic efficiency of the clinical diagnosis is still in urgent need.