不同检测方法对肺结核诊断价值的探讨

Comparison study on diagnostic value of different diagnostic procedures in pulmonary tuberculosis

目的 :探讨晨痰直接涂片、晨痰结核菌培养、诱导痰离心沉淀涂片 3种不同方法对肺结核的诊断价值。方法 :对 5 0例肺结核患者分别进行晨痰直接涂片 3次、晨痰结核菌培养、诱导痰离心沉淀涂片查找抗酸杆菌。结果 :痰直接涂片查找抗酸杆菌阳性 13例 (13/ 5 0 ,2 6 % ) ;痰结核菌培养阳性 17例 (17/ 5 0 ,34% ) ;5 0例患者全部诱导出痰液 ,痰量 10～ 4 0 ml,平均 (2 0 .0± 4 .5 ) ml;5 0例患者有 2例在诱导痰操作中感胸闷、气急 ,但完成操作 ,1例因操作过程中用力咳嗽而致操作后咽喉隐痛不适 ,但当日好转 ;诱导痰离心沉淀涂片找抗酸杆菌阳性 2 0例 (2 0 / 5 0 ,4 0 % ) ,明显高于痰结核菌培养及直接涂片阳性率 (P均 <0 .0 5 ) ,且检出大量排菌 (++++) 6例(6 / 2 0 )。结论 :诱导痰离心沉淀涂片查找抗酸杆菌阳性率高 ,不良反应小 ,在肺结核的临床诊断以及流行病学调查中具有重要意义 ,便于在基层推广。

Objective:To study the diagnostic value of morning sputum direct smear,morning sputum tuberculous bacillus culture,and induced sputum centrifugation sediment smear in the diagnosis of pulmonary tuberculosis.Methods:Morning sputum direct smear for 3 times,morning sputum tuberculosis bacillus culture,and induced sputum centrifugation sediment smear for acidfast bacillus were performed on 50 patients with pulmonary tuberculosis.Results:Direct smear of sputum for acidfast bacillus was positive in 13 patients(26%).Bacterial culture of sputum was positive in 17 patients(34%).Sputum was successfully induced in all 50 patients. The quantity of induced sputum was 1040 ml 〔mean (20 0±4 5) ml〕.Two patients complained of dyspnea and tachypnea during the procedure.One patient complained of some discomfort in the throat due to severe cough after inducing expectoration of sputum,but the symptom subsided on the same day.Induced sputum centrifugation sediment smear looking for acidfast bacillus was positive in 20 patients(20/50,40%). Its positive rate was significantly higher than that of bacterial culture and direct sputum smear(all P <0 05). Six patients discharging a large mumber of tuberculous bacilli ( ++++ ) were detected by induced sputum centrifugation sediment smear(6/20).Conclusions:It is concluded that induced sputum centrifugation sediment smear looking for acidfast bacillus has the advantages of high positive rate and few side effects.It has important significance for clinical diagnosis of pulmonary tuberculosis and epidemiological investigation and can be recommended to be used in grassroots hospitals.