输尿管镜检查联合实时荧光定量聚合酶链反应在不典型肾结核中的诊断价值

Ureteroscopy combined with real-time fluorescence quantitative PCR in diagnosis of atypical renal tuberculosis

目的探讨在不典型肾结核中,输尿管镜检查联合实时荧光定量聚合酶链反应(FQ-PCR)的应用及其诊断价值。方法回顾性分析2015年7月至2020年7月河北省胸科医院收治的43例不典型肾结核且入院后确诊肾结核的患者的诊治资料,采用尿沉渣和肾盂尿液的抗酸染色、结核菌培养和FQ-PCR-结核菌脱氧核糖核酸(TB-DNA)三种检测方法,比较其肾结核检出率的差异,并行输尿管镜检观察和做组织活检。结果(1)同种标本:FQ-PCR-TB-DNA阳性检出率>结核菌培养>抗酸染色[尿沉渣,60.47%,20.93%,4.65%,P<0.01;肾盂尿液,93.02%,76.74%,41.86%,P<0.01]。(2)同种检测方法:肾盂尿液的阳性检出率>尿沉渣[抗酸染色法,41.86%vs 4.65%,P<0.01;结核菌培养法,76.74%vs 20.93%,P<0.01;FQ-PCR-TB-DNA法,93.02%vs 60.47%,P<0.01]。(3)输尿管镜活检:39例镜下活检中,90.70%为结核,9.30%为慢性炎症。输尿管镜检查联合FQ-PCR的肾结核检出率显著高于尿沉渣(100.00%vs 60.47%,P<0.01);输尿管镜检并发症主要为新发肉眼血尿18例,新发尿频14例。结论输尿管镜检查联合FQ-PCR可显著提高不典型肾结核的临床检出率,可选择应用。

Objective To investigate the application and diagnostic value of ureteroscopy combined with real-time fluorescence quantitative polymerase chain reaction(FQ-PCR)in atypical renal tuberculosis.Methods A retrospective analysis was performed on the diagnosis and treatment data of 43 patients with atypical renal tuberculosis(who were diagnosed renal tuberculosis after admission)admitted to Hebei Chest Hospital from July 2015 to July 2020.The detection rates of renal tuberculosis were compared between three methods such as acid fast staining of urinary sediment and renal pelvis urine,Mycobacterium tuberculosis culture and FQ-PCR-tuberculosis deoxyribonucleic acid(TB-DNA).Ureteroscopy and tissue biopsy were performed.Results The positive rates detected by FQ-PCR-TB-DNA,Mycobacterium tuberculosis culture and acid-fast staining were 60.47%,20.93% and 4.65% in urine sediment,and 93.02%,76.74% and 41.86% in renal pelvis urine,respectively.The differences among three methods were statistically significant(P<0.01).The positive rates in urine from renal pelvis were significantly higher than those in urinary sediment,respectively by acid fast staining(41.86%vs 4.65%,P<0.01),Mycobacterium tuberculosis culture method(76.74%vs 20.93%,P<0.01)and FQ-PCR-TB-DNA method(93.02%vs 60.47%,P<0.01).Ureteroscopic biopsy in 39 cases showed 90.70% of tuberculosis and 9.30% of chronic inflammation.The detection rate of renal tuberculosis in renal pelvis urine by ureteroscopy combined with FQ-PCR was significantly higher than that in urinary sediment(100%vs 60.47%,P<0.01).The main complications of ureteroscopy were new gross hematuria(18 cases)and urinary frequency(14 cases).Conclusion Ureteroscopy combined with FQ-PCR can significantly increase the clinical detection rate of atypical renal tuberculosis and can be applied selectively.