分枝杆菌抗酸染色法及数字化摄影胸片检查支气管扩张在肺结核病临床诊断与治疗中的应用

Application of bacillus acid-fast staining and digital radiography X-ray films examining bronchiectasis in clinical diagnosis and treatment of pulmonary tuberculosis

目的:观察分枝杆菌抗酸染色法及数字化摄影(DR)胸片检查支气管扩张在肺结核病(PTB)临床诊断与治疗中的应用.方法:选取2019年1月〜2020年2月收治的疑似肺结核患者187例,接受DR胸片检查与分枝杆菌抗酸染色法检查,以痰培养结核分枝杆菌(MTB)为肺结核诊断金标准,观察DR胸片的影像学结果,比较DR胸片检查与分枝杆菌抗酸染色法对阳性检出率、阴性检出率、准确率、灵敏度及特异度的情况,确诊为肺结核患者给予2HRZE/4HR化疗方案,2个月强化治疗,4个月持续治疗,分别于治疗2、5、6个月后,行DR胸片与分枝杆菌抗酸染色法检查,观察患者治疗情况.结果:DR胸片对PTB阳性检出率显著高于抗酸染色检测(P<0.05);抗酸染色与DR胸片联合检测的准确单、特异度、敏感度显著高于抗酸染色与DR胸片单项检测(P<0.05);抗酸染色与DR胸片联合检查的漏诊率与误诊率显著低于抗酸染色与DR胸片单项检查(P<0.05)。结论:抗酸染色与DR胸片联合检查的准确率、特异度、敏感度显著高于抗酸染色与DR胸片单项检查,可用于PTB患者的初步筛选,对PTB的早期诊断与治疗方案的制定调整具有积极意义.

Objective:To evaluate bacillus acid-fast staining and digital radiography(DR)X-ray films examining bronchiectasis in clinical diagnosis and treatment of pulmonary tuberculosis(PTB).Methods:A total of 187 patients with suspected PTB who were admitted from January 2019 to January 2020 were enrolled All patients were examined for PTB by using both DR X-ray films and bacillus acid-fast staining method.Taking sputum culture of Mycobacterium tuberculosis(MTB)as the golden standard of PTB diagnosis,imaging results of DR X-ray films were observed The positive detection rate,negative detection rate,accuracy rate,sensitivity and specificity of DR X-ray films and bacillus acid-fast staining were compared.The patients confinned with PTB were treated with 2HRZE/4HR chemotherapy for 2-month intensive treatment and 4-month continuous treatment After 3 and 6 months of treatment,DR X-ray films and bacillus acid-fast stiiining examinations were perfonncd to observe treatment situations.Results:The positive detection rate of PTB by DR X-ray films was significantly higher than that by acid-fast staining(P<0.05).The accuracy,specificity and sensitivity of acid-fast staining combined with DR X-ray films were significantly higher than those of their single test(P<0.05).The missed diagnosis rate and misdiagnosis rate of acid-fast staining combined with DR X-ray films were significantly lower than those of their single test(P<0.05).Conclusion:The accuracy,specificity and sensitivity of acid-fast staining combined with DR X-ray films are significantly higher than those of their single test,which can be applied in preliminaryr screening of PTB patients,and are of positive significance for early diagnosis of PTB and development of treatment plans.