摘要
目的探讨离心涂片法、Gene Xpert技术和改良抗酸染色法应用于早期结核性脑膜炎诊断中的临床价值。方法选择2018年1月至2020年9月就诊于我院的120例脑膜炎患者为研究对象,采用离心涂片法、Gene Xpert技术和改良抗酸染色法对其脑脊液标本中的结核分枝杆菌进行检测。以临床综合诊断结果为金标准,比较三种方法对结核性脑膜炎的诊断价值。结果改良抗酸染色法对结核性脑膜炎的诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值均显著高于离心涂片法、Gene Xpert技术,且Gene Xpert技术显著高于离心涂片法,差异具有统计学意义(P<0.05)。改良抗酸染色法与临床综合诊断结果之间为高度一致性(Kappa值为0.829),Gene Xpert技术与临床综合诊断结果之间为中度一致性(Kappa值为0.634),离心涂片法与临床综合诊断结果之间为低度一致性(Kappa值为0.378)。三种方法对结核性脑膜炎Ⅰ期的诊断符合率从高至低依次为改良抗酸染色法、Gene Xpert技术、离心涂片法,两两比较,差异具有统计学意义(P<0.05);三种方法对结核性脑膜炎Ⅱ期、Ⅲ期的诊断符合率比较,差异无统计学意义(P>0.05)。结论相比于离心涂片法、Gene Xpert技术,改良抗酸染色法可以更加灵敏、准确地诊断早期结核性脑膜炎,值得在临床上推广应用。
Objective To explore the clinical value of centrifugal smear method,Gene Xpert technique and modified acid-fast stain in the diagnosis of early tuberculous meningitis.Methods A total of 120 patients with meningitis treated in our hospital from January 2018 to September 2020 were selected as the research objects.Mycobacterium tuberculosis in cerebrospinal fluid samples of patients were detected by centrifugal smear method,Gene Xpert technique and modified acid-fast stain.Taking the clinical comprehensive diagnosis results as the gold standard,the diagnostic value of the three methods for tuberculous meningitis was compared.Results The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the modified acid-fast stain in the diagnosis of tuberculous meningitis were significantly higher than those of the centrifugal smear method and the Gene Xpert technique,and those of the Gene Xpert technique were significantly higher than the centrifugal smear method,the differences were statistically significant(P<0.05).There was high consistency between modified acid-fast stain and clinical comprehensive diagnosis results(Kappa value was 0.829),moderate consistency between Gene Xpert technique and clinical comprehensive diagnosis results(Kappa value was 0.634),and low consistency between centrifugal smear method and clinical comprehensive diagnosis results(Kappa value was 0.378).The diagnostic coincidence rate of the three methods for stageⅠtuberculous meningitis from high to low was modified acid-fast stain,Gene Xpert technique and centrifugal smear method,and the differences were statistically significant(P<0.05).There were no significant differences between the three methods in the diagnosis coincidence rate of stageⅡand stageⅢtuberculous meningitis(P>0.05).Conclusion Compared with the centrifugal smear method and Gene Xpert technique,the modified acid-fast stain can be more sensitive and accurate in the diagnosis of early tuberculous meningitis,which is worthy of clinical promotion and application.
作者
黄波
周娜
HUANG Bo;ZHOU Na(Xi'an Gaoxin Hospital,Xi'an 710075,China)
出处
《临床医学研究与实践》
2021年第27期110-112,共3页
Clinical Research and Practice