武汉市病原学检测阴性肺结核诊断质量分析

Diagnostic quality analysis of negative etiological pulmonary tuberculosis test results in Wuhan

目的分析武汉市病原学检测阴性肺结核的诊断现状,为提高病原学阴性肺结核的诊断质量提供依据。方法从1个市级和2个区级定点医院整群抽取2019年1月1日至2月28日登记报告并完成治疗的241例病原学阴性肺结核患者,复核抽取患者的病案资料、胸部影像学检查和实验室检查结果,分析病原学检测阴性肺结核患者接受病原学检查及影像学检查质量。结果88.8%(214/241)患者符合病原学阴性肺结核诊断依据,96.3%(232/241)患者胸部影像学检查与原诊断结果判读一致,开展痰涂片检查、痰培养检查和分子生物学检测的患者分别占97.9%(236/241)、73.9%(178/241)、65.6%(158/241)。开展抗结核抗体检测、结核菌素皮肤试验、γ干扰素释放试验和诊断性抗感染治疗的患者分别占54.8%(132/241)、46.5%(112/241)、26.1%(63/241)和53.1%(128/241)。市级痰培养检查率高于中心城区和远城区,中心城区高于远城区,市级分子生物学检测率高于中心城区和远城区,差异有统计学意义(P<0.001);抗结核抗体检测率市级低于中心城区,差异有统计学意义(P<0.001),诊断性抗感染治疗率中心城区高于市级和远城区,市级高于远城区,差异有统计学意义(P<0.001)。结论应进一步规范市区级结核病定点医院病原学检测阴性肺结核的诊断行为,市级需提高诊断性抗感染治疗和辅助检查比例,区级需增加实验室病原学检查的频次和项目。

Objective To analyze the diagnosis status of negative etiological pulmonary tuberculosis test results in Wuhan,and to provide scientific basis for improving the diagnosis strategy of etiological negative pulmonary tuberculosis.Methods From January 1 to February 28,2019,a total of 241 patients with negative etiological tuberculosis who were registered,reported and treated in 1 municipal and 2 district-level designated hospitals were selected.The medical record data,chest imaging examination and laboratory examination results of the selected patients were reviewed and extracted,and the quality of etiological examination and imaging examination of patients with negative etiological pulmonary tuberculosis were analyzed.Results Among the 241 patients,88.8%(214/241)of the patients met the diagnostic criteria for negative etiological pulmonary tuberculosis,and 96.3%(232/241)of the patients had chest imaging examinations that were consistent with the original diagnostic results.Patients received sputum smear examination,sputum culture,and molecular biology test accounted for 97.9%(236/241),73.9%(178/241)and 65.6%(158/241),respectively.Patients received anti-tuberculosis antibody test,tuberculin skin test,γ-interferon release and diagnostic anti-infection treatment accounted for 54.8%(132/241),46.5%(112/241),26.1%(63/241),and 53.1%(128/241),respectively.The sputum culture detection rate of urban area was higher than those of central and remote urban areas,the rate of central urban area was higher than that of remote urban areas,and the molecular biology detection rate of urban area was higher than those of central and remote urban area,with statistical significance(P<0.001).The detection rate of anti-tuberculosis antibody of urban area was lower than that of central urban area,and the differences were statistically significant(P<0.001).The rate of diagnostic anti-infective therapy of central urban area was higher than that of urban area and the remote urban area,and the rate in urban area was higher than that of remote urban area,and the differences were statistically significant(P<0.001).Conclusion It is necessary to further standardize the diagnosis of negative etiological pulmonany tuberculosis of designated tuberculosis hospitals.The proportion of diagnostic anti-infection treatment and auxiliary examination at the municipal level needs to be increased,and the frequency and items of laboratory etiological examination at the district level need to be increased.