分枝杆菌实验室诊断方法比较

Comparison of the Laboratory Diagnostic Methods of Mycobacterium Spp

目的了解分枝杆菌实验室检测中培养、涂片抗酸染色及PCR-荧光探针法的应用情况与诊断价值。方法回顾2013年1月至2015年12月北京协和医院送检分枝杆菌的10 326份培养、25 269份涂片抗酸染色及5949份PCR-荧光探针法检测的标本种类分布及阳性标本检出率,比较3种检测方法的差异及诊断价值。结果培养法以血液标本数量最多(31.4%),涂片抗酸染色和PCR-荧光探针法均以痰标本数量最多(40.3%和40.4%)。PCR-荧光探针法阳性标本检出率(8.9%)明显高于培养(5.6%)和涂片抗酸染色(1.9%)(P<0.05)。以培养法为金标准,PCR-荧光探针法的敏感度(42.9%)高于涂片抗酸染色法(31.3%),特异度(95.2%)低于涂片抗酸染色法(97.4%)(P均<0.05)。结论 3种分枝杆菌实验室检测方法中,PCR-荧光探针法的阳性标本检出率和敏感度均较高,在实验室分枝杆菌属的检测中具有重要价值。

Objective To evaluate and compare the clinical values of Mycobacterium Spp culture,antiacid staining and Real-time FQ-PCR assay in the detection of Mycobacterium Spp infection. Methods From January 2013 to December 2015,10 326 specimens of Mycobacterium Spp culture,25 269 specimens of anti-acid staining and 5949 specimens of Real-time FQ-PCR assay from Peking Union Medical College Hospital were analyzed from the perspectives of specimen distribution and positive isolation rates to compare the difference of thesethree methods and assess their diagnostic values. Results From 2013 to 2015,among the methods of detecting Mycobacterium Spp,the main Mycobacterium Spp culture of smear samples were blood specimens（ 31. 4%）,while that of anti-acid staining and Real-time FQ-PCR were sputum specimens（ 40. 3% and 40. 4%）. Mycobacterium Spp isolation rate of Real-time FQ-PCR（ 8. 9%） was significantly higher than those of culture（ 5. 6%）and anti-acid staining（ 1. 9%）（ both P〈0. 05）. Using culture as the gold standard,the sensitivity of Real-time FQ-PCR assay（ 42. 9%） was higher than that of anti-acid staining（ 31. 3%）,but the specificity（ 95. 2%） of Real-time FQ-PCR assay was lower than that of anti-acid staining（ 97. 4%）（ P〈0. 05）. Conclusions Among the three laboratory diagnostic methods of Mycobacterium Spp,the Real-time FQ-PCR has the advantage of high isolation rate and high sensitivity. It is one of the effective methods for the detection of Mycobacterium Spp.