显微镜观察药物敏感性技术在菌阴肺结核中的诊断价值

Evaluation of microscopic observation drug susceptibility assay in detection of Mycobacterium tuberculosis in diagnosis of pulmonary tuberculosis with negative sputum

目的评价显微镜观察药物敏感性技术(MODS)快速检测肺泡灌洗液中结核分枝杆菌对菌阴肺结核的临床诊断价值。方法采集2013年1月1日至2016年12月31日该院就诊的菌阴肺结核和其他肺部疾病患者的肺泡灌洗液样本,应用MODS技术进行结核分枝杆菌检测,与传统罗氏培养法、抗酸染色涂片法结果进行比较。结果 MODS法中位培养天数为[11.0(7.5,18.5)]d;如以罗氏培养法为判别标准,则MODS检测肺泡灌洗液中结核分枝杆菌的特异度为65.0%、灵敏度为83.3%、阳性预测值(PPV)为54.3%、阴性预测值(NPV)为88.6%、正确性为71.1%。结论 MODS技术检测肺泡灌洗液中结核分枝杆菌具有快速、灵敏、简便等优点,可作为菌阴肺结核细菌学快速检测的新方法之一。

Objective To evaluate microscopic observation drug susceptibility （MODS）for testing of mycobacterium tuberculosis brocho-alveolar lavage fluid in diagnosis of pulmonary tuberculosis with negative sputum. Methods Mycobacterium tuberculosis in 150 brocho-alveolar lavage fluid samples collected from tuberculosis （TB） patients of the Shanghai Seventh People′s Hospital in January 1,2013 to December 31,2016 were detected directly by MODS,comparing to the results with Lowenstein-Jensen （L-J） method and Ziehl-Neelsen （Z-N） method. Results By the MODS,median culture period were 11 days （7.5,18.5）.The test results of sputum sample by MODS were highly concordance rate with the results of L-J.If the results of L-J was the golden standard,the sensitivity,specificity,positive predictive value （PPV）,negative predictive value （NPV） and accuracy were 83.3%,65.0%,54.3%,88.6% and 71.1%,respectively. Conclusion MODS assay could be used for rapid detection of pulmonary tuberculosis with negative sputum,which is a new method with rapid,simple,inexpensive and other advantages.