4种检测方法在结核病临床诊断中的应用价值

The application value of four detection methods in clinical diagnosis of tuberculosis

目的探讨结核分枝杆菌感染T细胞斑点试验(T-SPOT.TB)、结核分枝杆菌快速培养试验、结核分枝杆菌抗体免疫球蛋白M(IgM)与免疫球蛋白G(IgG)联合检测,以及痰液或肺泡灌洗液涂片4种肺结核诊断方法的临床诊断价值。方法选取该院2014年10月至2015年5月临床初次诊断为结核病,且尚未用药的住院患者516例,对所有患者行T-SPOT.TB、结核分枝杆菌快速培养试验、结核分枝杆菌抗体IgM与IgG联合检测和痰液或肺泡灌洗液涂片检测,计算并比较各方法的灵敏度。结果 T-SPOT.TB的灵敏度(88.76%)高于结核分枝杆菌快速培养试验(45.74%)、结核分枝杆菌抗体IgM与IgG联合检测(72.87%)、痰液或肺泡灌洗液涂片(17.25%),差异均有统计学意义(P<0.01)。结论 T-SPOT.TB在检测结核分枝杆菌感染、辅助结核病诊断方面具有很高的应用价值,同时联合其他检测方法可提高诊断率,满足不同的临床需要。

Objective To explore the clinical diagnostic value of four kinds of diagnostic methods,including pulmonary tuberculosis,including T-cell-based spot test for tuberculosis infection(T-SPOT.TB),rapid culture test for Mycobacterium tuberculosis,combined detection of IgM and IgG antibodies in tuberculosis and sputum or bronchoalveolar lavage fluid smear.Methods A total of 516 cases of patients who were initially diagnosed with tuberculosis and without medication were collected from October 2014 to May 2015 in this hospital.T-SPOT.TB,rapid culture test for Mycobacterium tuberculosis,combined detection of IgM and IgG antibodies in tuberculosis and sputum or bronchoalveolar lavage fluid smear were performed in all patients.The sensitivity of these methods were calculated and compared.Results The sensitivity of T-SPOT.TB(88.76%)was higher than that of rapid culture test for Mycobacterium tuberculosis(45.74%),combined detection of IgM and IgG antibodies in tuberculosis(72.87%)and sputum or bronchoalveolar lavage fluid smear(17.25%),all had statistically significant differences(P<0.01).Conclusion T-SPOT.TB might have significant application value for detecting Mycobacterium tuberculosis infection and assisting the diagnosis of tuberculosis.Meanwhile,combining with other detection methods could greatly improve the diagnostic rate and meet different clinical needs.