三种结核分枝杆菌检测方法在高原地区临床实验室中的应用

Application of three detection methods of Mycobacterium tuberculosis in clinical laboratory in plateau area

目的:采用涂片抗酸染色法、改良罗氏培养基培养法、结核分枝杆菌DNA荧光定量PCR法在高原地区临床实验室检测结核病中的应用价值。方法:选取青海省人民医院就诊患者疑似肺结核病患者190例、肺结核患者60例及非结核病患者50例的痰液标本分别用涂片抗酸染色法、改良罗氏培养基培养法、TB-DNA PCR进行结核分枝杆菌检测,将检测结果进行分析和比较。结果:涂片抗酸染色法、改良罗氏培养基培养法、TB-DNA PCR检测190例疑似肺结核病患者痰液标本阳性率分别13.2%、39.5%、47.4%,TB-DNA PCR阳性率高于改良罗氏培养基培养法和涂片抗酸染色法。三种方法检测60例肺结核患者及50例非结核病患者的灵敏度分别为16.6%、46.7%、85.0%,特异性分别为100.0%、84.9%、76.0%。阳性预测值分别为100.0%,77.8%,80.9%。阴性预测值分别为50.0%,58.4%,80.8%。TB-DNA PCR符合诊断率最高,为80.9%。结论:TB-DNA PCR与涂片抗酸染色法、改良罗氏培养基培养法相比,具有灵敏度高、特异性低、阳性预测值高,是辅助诊断结核病的有效检测方法。

Objective The application value of smear acid fast staining,modified Roche medium culture and fluorescence quantitative PCR of Mycobacterium tuberculosis DNA in the diagnosis of tuberculosis.Method The sputum samples of 190 suspected TB patients,60 TB patients and 50 non TB patients were detected by smear acid fast staining,modified Roche medium culture and TB-DNA PCR respectively.The results were analyzed and compared.Results The positive rates of sputum specimens of 190 patients with suspected pulmonary tuberculosis detected by smear acid-fast staining method,modified Roche culture method,and TB-DNA PCR were 13.2%,39.5%,and 47.4%,respectively.The positive rate of TB-DNA PCR was higher than that of modified Roche medium,modified Roche medium culture method was higher than acid fast staining method.60 cases of tuberculosis and 50 cases of non tuberculosis was detected,the sensitivity of three methods was 16.6%,46.7%and 85.0%.The specificity was 100.0%,84.9%,76.0%.The positive predictive value was 100.0%,77.8%,80.9%.The negative predictive value was 50.0%,58.4%,80.8%respectively.Conclusion Compared with the acid-fast staining method and modified Roche culture method,TB-DNA PCR is sensitive,rapid and quantifiable,and can be used as an effective detection method for tuberculosis-assisted diagnosis.