改良抗酸染色法检测胸腔积液中结核分枝杆菌对结核性胸膜炎的诊断

Diagnostic Value of a Modified Acid-fast Staining Protocol for Mycobacterium Tuberculosis Detection in Pleural Fluid Samples from Patients with Tuberculouspleuritis

目的评价改良抗酸染色法在结核性胸膜炎的诊断价值.方法选取2013年10月至2015年02月于西安市胸科医院诊治的胸腔积液患者,纳入实验组即结核性胸腔积液115例,对照组恶性胸腔积液36例,分别应用改良的抗酸染色法、传统的Ziehl-Neelsen染色法、BACTEC-MGIT 960培养检测,将BACTEC-MGIT 960培养结果作为参考标准,确定两种染色方法的灵敏度和特异性.结果以培养结果作为参考标准,改良染色法的灵敏度,特异度,阳性预测值(PPV),和阴性预测值(NPV)分别为72.2%,100%,100%,和52.9%;传统染色法分别为0,100%,0,和23.8%.结论改良抗酸染色法可明显提高结核性胸膜炎的阳性诊断率,具有简便、快速、准确的优点,能为结核性胸膜炎的诊断提供病原学依据,值得临床推广应用.

Objective To assess the diagnostic value of a modified acid-fast staining method intuberculouspleuritis. Methods A modified acid-fast staining protocol was used for Mycobacterium tuberculosis inpleural fluid samples. Detection rates of acid-fast bacilli （AFB） from 151 tuberculous pleural fluid samples werecompared between the modified- and traditional Ziehl-Neelsen- acid-fast staining protocols. Results from theBACTEC-MGIT 960 culture system,considered the reference standard,were used to determine sensitivity andspecificity of the modified staining method. ResultsWith bacterial culture as the reference standard,sensitivity,specificity,positive predictive value（PPV ）,and negative predictive value（NPV ） were 72.2%,100.0%,100.0% , and 52.9% , respectively, for the modified method, and 0% , 100% , 0% , and 23.8% ,respectively,for the traditional method. Conclusions The modified acid-fast staining method has a high detectionrate for AFB,and can constitute an important diagnostic tool for tuberculouspleuritis. As a simple, rapid andaccurate method, the modified acid-fast staining protocol may provide etiologic evidences for detectingtuberculouspleuritis.