肉芽肿性炎组织中结核分枝杆菌检出方法的对比分析及应用价值

Comparative Analysis of Detection Methods of Mycobacterium Tuberculosis in Granulomatous Inflammation Tissue and Its Application Value

目的 探讨肉芽肿性炎组织中结核分枝杆菌常用两种检查方法[抗酸染色和荧光定量PCR(FQ-PCR)]检出效能的大小,与其他实验室检测指标的关系及临床应用价值。方法 对373例石蜡包埋的肉芽肿性炎组织行抗酸染色和FQ-PCR检测,比较两者在各种病检组织中的阳性检出率、敏感度和特异度等方面的差异,同时分析它们与其他实验室检测指标的关系。结果 373例肉芽肿性炎的病例组织中,抗酸染色阳性率为19.57%,敏感度和特异度分别为60.38%、96.63%;结核分枝杆菌DNA(TB-DNA)的阳性率为27.35%,敏感度和特异度分别为94.34%、99.25%;在确诊结核病的病例中,CT影像、涂片抗酸染色、T-SPOT.TB、γ-干扰素释放试验(IGRAs)、TB特异性细胞免疫反应等影像和实验室检查的阳性率分别为82.47%、6.45%、96.00%、80.00%、82.35%。结论 抗酸染色和TB-DNA两者在肉芽肿性炎组织中的联合检测对早期确诊结核病有重要意义,其中TB-DNA有较高的检出率和特异性,与其他实验室检测指标一起可以提高结核分枝杆菌的检出率。

Objective To investigate the detection efficiency of two commonly used methods [acid-fast staining and fluorescence quantitative PCR(FQ-PCR)] for Mycobacterium tuberculosis in granulomatous inflammation tissue, the relationship between them and other laboratory detection indicators and their clinical application value.Methods A total of 373 paraffin-embedded granulomatous tissues were detected by acid-fast staining and FQ-PCR. The differences in positive rate, sensitivity and specificity of the two methods were compared, and their relationship with other laboratory indicators was analyzed. Results In 373 cases of granulomatous inflammation tissues, the positive rate of acid-fast staining was 19.57%, the sensitivity and specificity were 60.38%, 96.63%, respectively. The positive rate of Mycobacterium tuberculosis DNA(TB-DNA) was 27.35%, the sensitivity and specificity were 94.34%, 99.25%, respectively. The positive rates of CT imaging, acid-fast staining, T-SPOT.TB, interferon-gamma release assay(IGRAs) and TB-specific cellular immune reaction were 82.47%, 6.45%, 96.00%, 80.00% and 82.35%, respectively. Conclusion The combined detection of acid-fast staining and TB-DNA in granulomatous tissue is important for early diagnosis of tuberculosis, while TB-DNA has higher detection rate and specificity, which can improve the detection of Mycobacterium tuberculosis together with other clinical laboratory detection indicators.