多指标联合检测在菌阴肺结核诊断中的价值研究

Study on the value of multi-index combined detection in the diagnosis of mycobacterium tuberculosis

目的研究痰或肺泡灌洗液荧光定量TB-DNA、结核菌噬菌体检测结核菌及T-SPOT多指标联合检测在菌阴肺结核诊断中价值。方法选取2010年10月~2012年10月在本院诊疗的患者223例,分为初治的菌阴肺结核组108例、初治的菌阳肺结核组55例和非肺结核病组60例。对入选患者进行常规检测,同时进行血T-SPOT、结核菌噬菌体检测结核菌和痰或肺泡的灌洗液TB-DNA;对患者的检测结果记录、分析,研究以上3项检查的单项特异性和敏感性,及3项检测结合的诊断价值。结果 3项检查中每个项目检查的特异性均达到了90%以上,菌阴肺结核组和菌阳肺结核组的阳性人数都远大于非肺结核组的人数,3组比较差异明显;联合检测指标的增加,菌阴肺结核中的阳性检出率也随之增加。有T-SPOT参与的检测其阳性率都高于没有T-SPOT参与的检测,差异有统计学意义(P<0.05);联合检查在菌阴肺结核组和非肺结核组同时阳性的检出率差异有统计学意义(P<0.05)。结论 T-SPOT的检查、结核菌噬菌体检测结核菌和TB-DNA的检查多个项目指标联合检测比单一的检测更能提高菌阴肺结核的诊断敏感性,其中含有T-SPOT检查参与的结合检查更可以提升菌阴肺结核的检查率。

Objective To study the value of sputum or bronchoalveolar lavage fluid fluorescence quantitative TB-DNA, mycobacterium tuberculosis phage detection, mycobacterium tuberculosis and T-SPOT multi-target detection in the diagnosis of pulmonary tuberculosis. Methods A total of 223 patients in our hospital were enrolled from October 2010 to October 2012. The patients were divided into three groups：the untreated, patients diagnosed with bacterium-positive pulmonary tuberculosis and patients with non-pulmonary tuberculosis. TB-DNA was detected in the blood of the selected patients using routine T-SPOT and mycobacterium tuberculosis bacteriophage tests; sputum or alveoli tests were also used. The patients＆#39; detection results were recorded and analyzed. The specificity and sensitivity values of the above three tests were analyzed, as was the combination of the three tests. Results The specificity of each item in the three tests was greater than 90%. The numbers of positive bacteria in the tuberculosis and bacterium-positive pulmonary tuberculosis groups were much larger than in the non-tuberculosis group. The number of positive bacteria detected in pulmonary tuberculosis cases also increased. The detection rate of the T-SPOT test was statistically significantly higher as well （P 〈 0.05）, and the detection rate of the T-SPOT test was significantly higher than in the non-tuberculosis group. There was a significant difference in the positive rate of positive bacteria between the negative group and the non-pulmonary tuberculosis group（P〈0.05）. Conclusion The combination of the T-SPOT test, mycobacterium tuberculosis detection and TB-DNA detection can improve the diagnosis of bacterium-negative pulmonary tuberculosis. This includes the use of the T-SPOT test to check the accuracy of the combined examination;it can also improve the detection of bacterium-negative tuberculosis.