不同支气管镜介导标本的TB-DNA检测对痰涂片阴性肺结核患者的诊断价值研究

Study on the diagnostic value of TB-DNA mediated since different bronchoscope for patients with negative pulmonary tuberculosis of sputum smear

目的:分析不同支气管镜介导标本的结核分枝杆菌基因(TB-DNA)检测对痰涂片阴性肺结核患者的诊断价值。方法:前瞻性选取234例痰涂片阴性肺结核患者,对所有受检者均用肺泡灌洗液提取标本和毛刷刷检收集痰液标本,后行荧光定量PCR检测TB-DNA,观察两种介导标本的诊断结果,对比阳性检出率。结果:肺泡灌洗液提取标本采用TB-DNA检测阳性诊断率为61.54%,低于黏膜毛刷刷检提取标本的阳性诊断率91.03%,差异具有统计学意义(x^2=19.32,P<0.05);234例患者均顺利完成支气管镜检查,其中1例患者发生黏膜出血,2例气促,1例气胸,事件发生率为1.7%,给予对症处理后均缓解。结论:支气管镜下采用黏膜毛刷刷检取材后行荧光定量PCR检测TB-DNA对于痰涂片阴性肺结核患者具有较高诊断效能。

Objective: To analyze the diagnostic value of TB-NDA detection mediated since different bronchoscope for patients with negative pulmonary tuberculosis of sputum smear. Methods: 234 patients with pulmonary tuberculosis who were negative sputum smear were prospectively selected, and the specimens of all subjects were extracted by using alveolar lavage fluid and the sputum specimen of them were collected by using hairbrush. And then, fluorescence quantitative PCR was used to detect TB-DNA. The diagnostic results of two kinds of mediated specimens were observed and the positive relevance ratio of them were compared. Results: The positive diagnostic rate of TB-DNA in alveolar lavage fluid (61.54%) was significantly lower than that in mucosal brush inspection (91.03%)(x2=19.32, P<0.05). All of patients smoothly were implemented bronchoscope examination, and 1 case occurred mucous hemorrhage, and 2 cases occurred shortness of breath, and 1 case occurred pneumothorax. The occurrence rate of adverse event was 1.7%, and all of these symptoms were relieved after they received expectant treatment. Conclusion: The detection of TB-DNA of fluorescent quantitative PCR with brush inspection of mucous brush under bronchoscope has a high diagnostic efficiency for patients with negative pulmonary tuberculosis of sputum smear.