儿童肺结核病实验室诊断方法的建立及应用评价

Establishment and application of laboratory diagnostic methods for tuberculosis in children

目的评价多种实验室检测方法对儿童肺结核病诊断的意义。方法收集2015年1月-2016年12月收治的76例临床诊断肺结核病患儿(疾病组)及同时期收治的80例非结核病患儿(对照组)口腔痰液、血清及全血标本,分别进行痰涂片法(Sputum smear)、PCR、蛋白芯片法(TB-DOT)、干扰素-γ体外释放(TB-IGRA)试验。试验结果通过统计学方法完成真实性评价。结果痰涂片法、TB-PCR、TB-DOT、TB-IGRA检测的灵敏度分别为26.32%、25.00%、60.53%、93.75%。4种方法中TB-IGRA的灵敏度最高,差异有统计学意义(χ2值分别为13.057、56.308、54.047,P<0.01);特异度分别为100.00%、100.00%、93.75%、90.00%。TB-IGRA特异度最低,但与蛋白芯片法差异无统计学意义(χ2=0.754,P>0.05)。结论 TB-IGRA试验及TB-DOT检测具有较高的灵敏度及特异度,可以作为儿童肺结核病的辅助诊断工具。

Objective To evaluate the significance of multiple laboratory tests in the diagnosis of tuberculosis in children.Methods 76 children with tuberculosis（ medical group） and 80 children without tuberculosis（ control group） were enrolled in this study from January 2015 to December 2016. Patients were treated with sputum smear,polymerase chain reaction（ TB-PCR）,colloidal gold（ TB-DOT） and interferon gamma release assay（ TB-IGRA） respectively in patients with sputum,serum and whole blood samples. Statistical method was used to make the authenticity evaluation. Results The sensitivity of the sputum smear method,TB-PCR,TB-DOT and TB-IGRA was respectively 26. 32%,25. 00%,60. 53% and 93. 75%. The sensitivity of TB-IGRA was the highest among the four methods,and the differences were statistically significant（ χ2= 13. 057,56. 308,54. 047,P〈0. 01）. The specificity was 100. 00%,100. 00%,93. 75%,90. 00%,respectively. TB-IGRA had the lowest specificity,but there was no statistical significance on the difference with protein chip method（ χ^2= 0. 754,P〈0. 05）. Conclusion TB-IGRA and TB-DOT have high sensitivity and specificity,and can be used as an adjunctive diagnosis for children with tuberculosis.