液基细胞学涂片法检测痰抗酸杆菌对肺结核的诊断价值

Diagnostic value of liquid-based cytology test for sputum acid fast bacilli in pulmonary tuberculosis

目的探讨液基细胞学涂片法检测痰抗酸杆菌对肺结核的诊断价值。方法选择新乡医学院第一附属医院结核内科2017年6~8月收治的251例肺结核患者为研究对象,留取所有患者的夜间痰、晨痰、即时痰各1份,采用液基细胞学涂片法、直接涂片法和罗氏培养法检测痰抗酸杆菌,比较3种方法对痰抗酸杆菌的阳性检出率;并以罗氏培养法为金标准,比较直接涂片法和液基细胞学涂片法检测痰抗酸杆菌诊断肺结核的灵敏度及特异度。结果直接涂片法、液基细胞学涂片法和罗氏培养法对晨痰抗酸杆菌的阳性检出率高于夜间痰和即时痰(χ~2=7.492、18.323、4.111、19.443、4.349、18.305,P<0.05)。液基细胞学涂片法、罗氏培养法检测夜间痰、晨痰、即时痰抗酸杆菌的阳性检出率高于直接涂片法(χ~2=8.690、5.024、4.594、11.288、7.386、7.571,P<0.05);液基细胞学涂片法检测夜间痰、晨痰、即时痰抗酸杆菌的阳性检出率与罗氏培养法比较差异无统计学意义(χ~2=0.179、0.232、0.392,P>0.05)。直接涂片法、液基细胞学涂片法和罗氏培养法对血痰抗酸杆菌的阳性检出率高于脓性痰、黏液痰、唾液痰(χ~2=4.102、43.867、28.275、4.107、76.758、31.772、4.214、56.033、27.490,P<0.05)。液基细胞学涂片法、罗氏培养法对脓性痰、血痰、黏液痰、唾液痰抗酸杆菌的阳性检出率高于直接涂片法(χ~2=9.814、11.943、5.061、4.174、4.103、8.361、26.054、23.941,P<0.05);液基细胞学涂片法检测脓性痰、血痰、黏液痰、唾液痰抗酸杆菌的阳性检出率与罗氏培养法比较差异无统计学意义(χ~2=0.106、0.045、1.539、0.056,P>0.05)。以罗氏培养法作为金标准,直接涂片法检测痰抗酸杆菌的灵敏度和特异度分别为40.33%、94.41%,液基细胞学涂片法检测痰抗酸杆菌的灵敏度和特异度分别为70.72%、93.18%,液基细胞学涂片法检测痰抗酸杆菌的灵敏度高于直接涂片法(χ~2=33.507,P<0.05),液基细胞学涂片法与直接涂片法检测痰抗酸杆菌的特异度比较差异无统计学意义(χ~2=0.237,P>0.05)。结论液基细胞学涂片法检测痰抗酸杆菌阳性检出率、灵敏度和特异度高,且生物安全性好。

Objective To investigate the diagnostic value of liquid-based cytology test for sputum acid fast bacilli in pulmonary tuberculosis.Methods A total of 251 patients with tuberculosis in the Department of Tuberculosis of the First Affiliated Hospital of Xinxiang Medical University from June to August 2017 were selected as the study subjects.One copy of sputum at night,one copy of sputum in the morning and one copy of sputum in the instant were collected from all the patients.At the same time,liquid-based cytology smear method,direct smear method and Roche culture method were used to detect acidfast bacillus.The positive detection rates of the three methods for acid-fast bacillus was compared.The sensitivity and specificity of direct smear and liquid-based cytological smear for the diagnosis of pulmonary tuberculosis were compared using Roche culture method as the gold standard.Results The positive rates of acid-fast bacilli in morning sputum by direct smear,liquid-based cytological smear and Roche culture were higher than those of night sputum and instant sputum(χ~2=7.492,18.323,4.111,19.443,4.349,18.305;P<0.05).The positive detection rates of acid-fast bacteria in night sputum,morning sputum and instant sputum detected by liquid-based cytology smear and Roche culture were higher than those by direct smear(χ~2=8.690,5.024,4.594,11.288,7.386,7.571;P<0.05);there was no significant difference between liquid-based cytology smear and Roche culture in the positive detection rates of acid-fast bacteria in night sputum,morning sputum and instant sputum(χ~2=0.179,0.232,0.392;P>0.05)The positive rates of acid-fast bacilli in blood sputum detected by direct smear,liquid-based cytological smear and Roche culture were higher than those of purulent sputum,mucus sputum and salivary sputum(χ~2=4.102,43.867,28.275,4.107,76.758,31.772,4.214,56.033,27.490;P<0.05).The positive detection rate of acid-fast bacilli in purulent sputum,blood sputum,mucus sputum and salivary sputum detected by liquid-based cytology smear and Roche culture method was higher than that by direct smear method(χ~2=9.814,11.943,5.061,4.174,4.103,8.361,26.054,23.941;P<0.05);there was no significant difference in the positive detection rate of acid-fast bacilli in purulent sputum,blood sputum,mucus sputum and salivary sputum between the liquid-based cytology smear method and Roche culture method(χ~2=0.106,0.045,1.539,0.056;P>0.05).The sensitivity and specificity of direct smear were 40.33%and 94.41%respectively.The sensitivity and specificity of liquid-based cytology smear method for detecting acid-fast bacilli in sputum were70.72%and 93.18%respectively.The sensitivity of liquid-based cytological smear method for detecting acid-fast bacilli in sputum was higher than that of direct smear method(χ~2=33.507,P<0.05);there was no significant difference in specificity between liquid-based cytological smear and direct smear(χ~2=0.237,P>0.05).Conclusion The positive detection rate,sensitivity and specificity of sputum-resistant bacillus detected by liquid-based cytology smear are high and the biosecurity is good.