区域性结核病实验室结核杆菌检测方法比较研究

Comparative study on detection methods of Mycobacterium tuberculosis in Regional Tuberculosis Laboratory

目的比较区域性结核病实验室结核杆菌3种检验方法[抗酸染色法、液体培养法以及实时荧光聚合酶链式反应(PCR)法]结核杆菌检出率、结果符合率、检测周期及费用,为各级医疗机构临床医生选择合适的检验方法提供科学依据。方法选取区域性结核病实验室2018年5月至2021年8月初诊患者1169例晨痰标本作为研究对象。其中,男830例,女339例,年龄10~89岁,每份标本分别采用上述3种方法进行检测,并用χ^(2)检验对结核杆菌检出率进行分析,对结果符合率、检测周期、费用进行比较。结果1169例晨痰标本中,抗酸染色法、液体培养法、实时荧光PCR法阳性率分别为16.6%(194/1169)、28.1%(329/1169)、26.1%(305/1169);统计显示抗酸染色法与液体培养法检测结果差异有统计学意义(χ^(2)=44.888,P<0.001),抗酸染色法与实时荧光PCR法检测结果差异有统计学意义(χ^(2)=31.391,P<0.001),液体培养法和实时荧光PCR法检测结果差异无统计学意义(χ^(2)=1.247,P>0.05),但3种检验方法结果符合率较高。抗酸染色法、液体培养法以及实时荧光PCR法检测周期分别为30 min、6周、2 h,费用分别为15元、100元、800元。结论液体培养法和实时荧光PCR法的结核杆菌检出率较抗酸染色法高,但抗酸染色法费用低,检测周期较液体培养法和实时荧光PCR法短。实时荧光PCR法较其他2种方法灵敏度高,特异性强,但价格昂贵。虽然3种检验方法各有优缺点,但它们的结果符合率较高。

Objective To compare detection rates,coincidence rates,detection cycles,and costs of three detection methods[acid fast staining,liquid culture,and real-time fluorescence polymerase chain reaction(PCR)]in the detection of Mycobacterium tuberculosis in the Regional Tuberculosis Laboratory,and to provide scientific basis for clinicians to select suitable detection methods.Methods The morning sputum samples of 1169 patients in the Regional Tuberculosis Laboratory from May 2018 to August 2021 were selected as the research objects.Among the patients,there were 830 males and 339 females,and they were 10 to 89 years old.Each sample was tested by the above three methods,and the detection rates of Mycobacterium tuberculosis were analyzed byχ^(2) test.The coincidence rates,detection cycles,and costs were compared.Results The positive rates of acid fast staining,liquid culture,and real-time fluorescent PCR were 16.6%(194/1169),28.1%(329/1169),and 26.1%(305/1169),respectively,with statistical differences between acid fast staining and liquid culture(χ^(2)=44.888,P<0.001),between acid fast staining and real-time fluorescent PCR(χ^(2)=31.391,P<0.001),and no statistical difference between liquid culture and real-time fluorescence PCR(χ^(2)=1.247,P>0.05),but the results of the three detection methods were consistent.The detection cycles of acid fast staining,liquid culture,and real-time fluorescence PCR were 30 minutes,6 weeks,and 2 hours,and the costs were 15 yuan,100 yuan,and 800 yuan,respectively.Conclusions The detection rates of Mycobacterium tuberculosis by liquid culture and real-time fluorescence PCR are higher than that by acid fast staining,but the cost of acid fast staining is lower and the detection cycle is shorter than those by liquid culture and real-time fluorescence PCR.Real time fluorescent PCR is more sensitive and specific than the other two methods,but it is expensive.Although the three detection methods have their own advantages and disadvantages,their results are consistent.