血性标本对实时荧光定量PCR检测的影响

目的探讨血性标本在PCR-DNA-Tb检测中影响。方法用23例非血性标本和37例血性标本同时直接法和预处理法进行实时荧光定量PCR-DNA-Tb检测。结果23例非血性标本两法检测结果差异无显著性(P>0.05),37例血性标本预处理法与直接法检测结果差异显著(P<0.01)。结论血性标本预处理后进行PCR-DNA-Tb检测可提高检出阳性率,减少假阴性。

荧光定量PCR对痰涂片阴性肺结核的临床诊断价值

目的探讨荧光定量PCR检测对痰涂片阴性的肺结核的诊断价值。方法采集180例痰涂片阴性的肺结核病患者及100例非结核性肺部疾病患者(肺炎、肺癌及矽肺患者)的支气管灌洗液(BALF),应用荧光定量PCR检测BALF中的TB-DNA,同时进行BALF结核杆菌培养及抗酸染色法检查结核杆菌,比较不同方法对肺结核的临床诊断效率。结果肺结核组中BALF中TB-DNA阳性检出率为62.77%,显著高于BALF抗酸染色法的阳性检出率33.89%(P<0.05),与BALF结核杆菌培养法无明显统计学差异(P>0.05),治疗1个月后TB-DNA的阳性检出率也高于抗酸染色法(P<0.05)。结论荧光PCR定量检测TB-DNA能提高结核杆菌的检出率,可作为诊断及判断疗效的方法。

巨噬细胞内结核分枝杆菌DNA的检测及实验评价

The Mycobacterium tuberculosis NDA in the macrophages from the different clinical specimens,such as ascites,pleurorrhea,CSF,BALF and blood,is detected with polymerase chain reaction (PCR).The results indicate that the test specificity is 96%,the precision is 92% and the sensitivity is 88%.The Separated and purified macrophage in a good specimen in the detecting TB-DNA by PCR.The test specificity and precision are high.The test is a good method of the diagnosis of the tuberculosis,specially the patient with the outer-pulmonary tuberculosis.The exact significance in the basic theory and the clinical practice are not affirmed.so it will be investigated further.

囊性病变细针吸取细胞学结果分析

目的探讨细针吸取细胞学(FNAC)在囊性病变中的应用价值。方法统计2002～2005年共106例来自甲状腺、乳腺、淋巴结、颌下肿块等部位的囊性病变细胞学结果,部分病例同时取得组织学及分子生物学结果。结果106例囊性病变中细胞学诊断恶性病变6例,另有23例获得组织学结果,细胞学与组织学的符合率为21/23。细胞学诊断为结核性病变的9例中6例采用PCR检测TB-DNA均为阳性,符合率为6/6。结论FNAC在囊性病变的诊断中有重要参考价值,囊性病变中的恶性疾病应引起重视,FNAC结合其他技术可提高诊断囊性病变的准确性。

几种方法对胸腔积液诊断价值的比较

比较几种方法对３０例胸腔积液的病因诊断价值。发现胸膜活检术简便易行、安全可靠；胸液结核菌脱氧核糖核酸聚合酶联反应具有快速、高灵敏、高特异性；胸液癌胚抗原检测对初步鉴别结核或肿瘤所致胸腔积液有实用价值；测定胸液／血乳酸脱氢酶和胸液沉渣找癌细胞及结核杆菌和结核杆菌培养，其实用价值有限。

同种肾移植术后的神经系统并发症

同种肾移植术后的神经系统并发症天津市泌尿外科研究所吴长利，马腾骧白求恩医大三院泌尿科常喜华，肖连升我院自１９７８年至１９９２年共施行尸体肾脏移植３２０例。出现神经系统并发症１４例，现报告如下：临床资料男１１例，女３例。年龄２７—５６岁，平均３４岁。全...

Diagnostic Value of TB-IGRA, PPD, TB-DNA-PCR and TB-Ab in Silicosis Complicated with Tuberculosis

Purpose: The purpose of this article is to investigate the clinical value of TB-IGRA (Tuberculosis-Interferon Gamma Release Assay), PPD (Intradermal Terbuculin Test), TB-DNA-PCR (Tuberculosis-Deoxyribonucleic-Polymerase Chain Reaction) and TB-Ab (Tuberculosis-Antibody) in diagnosing silicosis complicated with pulmonary tuberculosis. Methods: 53 cases of suspected silicosis complicated with pulmonary tuberculosis were selected in the time span ranging from February 2017 to May 2019. TB-IGRA test, PPD test, TB-DNA-PCR and TB-Ab detection were performed. The sensitivity, specificity, positive predictive value and negative predictive value were calculated. Results: Silicosis and pulmonary tuberculosis were diagnosed in 11 cases, with an incidence of 20.75%. The positive rates of TB-IGRA, PPD, TB-DNA-PCR and TB-Ab were 66.04%, 30.19%, 5.67% and 26.42%, respectively. The sensitivity was 90.91%, 81.82%, 27.27% and 54.55% respectively. The specificity was 42.86%, 80.95%, 100% and 80.95% respectively. The positive predictive values were 28.57%, 50%, 100% and 42.86% respectively. The negative predictive values were 94.44%, 91.89%, 84% and 87.18%. The positive rate, sensitivity and negative predictive value of TB-IGRA were the highest, while the specificity of TB-DNA-PCR was the highest yet with low positive rate, sensitivity and positive predictive value. Conclusion: The positive rate and sensitivity of TB-IGRA were high, yet with poor specificity, so it was impossible to judge whether the cases belonged to active pulmonary tuberculosis. The combination of PPD and TB-DNA-PCR could improve the sensitivity, specificity and positive predictive value, and the diagnostic accuracy of active pulmonary tuberculosis, which showed satisfactory clinical value.

实时荧光PCR与BACTEC MGIT 960快速培养在初治痰涂片阴性未受抗结核治疗的肺结核诊断中的应用

目的:探讨实时荧光PCR与BACTEC MGIT 960分枝杆菌快速培养(快速培养法)准确诊断初治痰涂片阴性(涂阴)且未经受抗结核治疗的肺结核可能性。方法:实验组:368份临床诊断活动性肺结核患者的初治涂片阴性痰标本;对照组:55份非结核性肺部疾病患者的痰液标本。用FQ-PCR技术、快速培养法及改良罗氏培养参考法对两组标本进行分析,观察指标为TB-DNA和结核菌阳性率。结果:实验组和对照标本中FQPCR技术、快速培养法和改良罗氏培养参考法检测的TB-DNA或结核菌阳性率分别为:16.85%、23.37%、22.01%和1%、0%、0%。三种方法分别平均耗时3h、9.6d和28d。以改良罗氏培养参考法为参照,FQ-PCR法和快速培养法的敏感性分别为69.1%和100%;特异性分别为91.2%和98.6%。结论:FQ-PCR和快速培养法均能提高初治涂阴肺结核患者的早期确诊率,但FQ-PCR的敏感性尚需进一步提高。

3种分子检测技术在结核病实验室诊断中的应用评价

目的:评估3种检测技术在结核病诊断中的价值。方法:对疑似结核病患者180例和非结核病患者150例分别用改良罗氏培养基培养法、结核分枝杆菌RNA荧光定量PCR法、结核分枝杆菌DNA荧光定量PCR法和Xpert MTB/RIF进行结核分枝杆菌的检测,将结果进行统计学比较与分析。结果:痰分枝杆菌培养法、TB-DNA PCR、TB-RNA PCR和Xpert MTB/RIF检测疑似肺结核患者痰液标本的阳性率分别为30.6%、45.6%、40.5%、47.4%。3者均高于痰分枝杆菌培养法(P<0.05),差异有统计学意义。分别对非肺结核患者的痰液标本检测,TB-DNA PCR和分子检测技术Xpert MTB/RIF各检出2例和1例。结论:结核分枝杆菌3种新型分子检测技术与传统痰分枝杆菌培养法比较,在敏感性和特异性上均有优势,显著缩短了诊断时间。

慢性肾衰患者并发结核病的诊断结核菌DNA-PCR与抗PPD-IgG的比较

慢性肾衰患者的结核病发生率高，肺外结核多见，缺乏特异的临床表现，故诊断较为困难。本研究检测了１１例慢性肾衰并发结核患者的血中结核菌ＤＮＡ－ＰＣＲ和血清抗ＰＰＤ～ＩｇＧ（ＥＬＩＳＡ），并检测了其中５例患者的渗出液（肺、腹水）及排泄物（尿，痰），结果表明，在血中，抗ＰＰＤ－ＩｇＧ的阳性率明显高于结核菌ＤＮＡ－ＰＣＲ，在渗出液或排泄物中，二者的阳性率大致相同．提示在尿毒症患者这一特定的人群中，血清或渗出液（排泄物）中抗ＰＰＤ－ＩｇＧ的检测对诊断结核有重要意义。

一次性使用炭肾160例临床应用报告

本文回顾了１９８８～１９９４年一次性使用炭肾对于安眠镇静药物、有机磷农药及毒鼠药中毒救治的应用。８５例安眠镇静药物中毒抢救成功率８９．４％，３２例有机磷中毒抢救成功率６８．８％。此外，对于详地黄中毒、毒蕈中毒、流行性出血热、肝性脑病、慢性肾衰、精神分裂症，一次性使用炭肾行血液灌流均有一定的疗效。提示急性重度药物或毒物中毒，特别是混合性药物中毒，应首选血液灌流治疗。

Diagnostic Value of TB-IGRA, PPD, TB-DNA-PCR and ADA in Tuberculous Pleural Effusion

Objective: To investigate the clinical diagnostic value of TB-IGRA (Tuberculosis-Interferon Gamma Release Assay), PPD (Intradermal Tuberculin Test), TB-DNA-PCR (Tuberculosis-Deoxyribonucleic-Polymerase Chain Reaction) and ADA(Adenosine Aeaminase) in tuberculous pleural effusion. Methods: 60 patients with tuberculous pleural effusion discharged from our department from January 1, 2018 to December 31, 2019 were selected. Moreover, the TB-IGRA in peripheral blood, PPD test, TB-DNA-PCR and ADA in pleural effusion were detected. Subsequently, the positive rate, negative rate, sensitivity and omission diagnostic rate of TB-IGRA, PPD, TB-DNA-PCR, ADA and combined TB-IGRA were calculated. Results: The positive rate and sensitivity of TB-IGRA, PPD,TB-DNA-PCR, and ADA were 95%, 71.67%, 5% and 86.67% respectively. The omission diagnostic rate was 5%, 28.33%, 95% and 13.33%. TB-IGRA showed the highest positive rate and sensitivity, and TB-DNA-PCR represented the highest omission diagnostic rate. The sensitivity of TB-IGRA + PPD was 98.33%, while the omission diagnostic rate was 51.67%. The sensitivity of TB-IGRA + TB-DNA-PCR was 95%, while the omission diagnostic rate was 5%. The sensitivity of TB-IGRA + ADA was 100%, while the omission diagnostic rate was 0%. In addition, the TB-IGRA + ADA had the highest sensitivity and the lowest omission diagnostic rate. Conclusion: TB-IGRA has high positive rate, high sensitivity and low omission diagnostic rate, which is superior to the traditional sputum test for tuberculosis. Notably, the combination of PPD, TB-DNA-PCR, ADA is capable of improving the diagnosis rate, and the diagnosis rate can reach 100% when combined with ADA, which is able to provide solid diagnostic value in clinical practice.

利用PCR技术检测肾结核患者血和尿中TB-DNA的结果及分析

笔者利用ＰＣＲ技术检测了５例疑似肾结核患者血和尿中的ＴＢ－ＤＮＡ。结果显示所有患者的尿中ＴＢ－ＤＮＡ均阳性，其中４例患者的血中ＴＢ－ＤＮＡ也阳性。血和尿中ＴＢ－ＤＮＡ均阳性可能会为临床上确诊为结核提供可靠依据。

1例肺结核误诊为肺癌病例分析并文献复习

本文回顾性分析我院1例误诊为肺恶性肿瘤患者的临床资料,并进行相关文献复习。研究中的患者肺内表现为左肺门肿大及左肺下叶团块,PET-CT还可见腹部淋巴结肿大,伴标准摄取值升高。患者电子支气管镜EBUS-GS穿刺病理结果为阴性。后行胸腔镜手术切除左下肺病灶,术后冰冻病理曾一度考虑梭状细胞癌可能。后石蜡病理见大量多核巨细胞反应,肉芽肿形成,未见核异性细胞及肿瘤依据。最终诊断主要依靠石蜡包埋组织标本采用PCR扩增技术检测到结核分枝杆菌DNA片段。故肺内占位伴淋巴结肿大的患者,不仅要考虑恶性肿瘤的可能。随着PCR技术的发展,为诊断结核提供了新方法,在做抗酸染色及病理诊断的同时,推荐进行PCR检测提高诊断的准确性。

尿TB-DNA阳性检出率的影响因素分析

目的分析在诊断肾结核时影响尿聚合酶链反应结核菌(尿TB-DNA)阳性检出率的因素。方法回顾性分析2015年5月—2020年05月郑州大学第一附属医院103例诊断为肾结核患者的临床资料,排除未行尿TB-DNA检测、肾动态及CT尿路造影(CTU)的患者,82例纳入研究,82例患者均行尿TB-DNA检测、肾动态、泌尿系超声及CTU检查。以病理诊断为金标准,根据术前尿TB-DNA是否呈阳性分为两组。比较两组患者两组年龄、性别,左右侧患肾、患肾合并结石及患肾功能受损参数的差异,运用二分类Logistic回归进行多因素分析。结果尿TB-DNA阴性组诊断前口服抗生素、肾积水相比于尿TB-DNA阳性组,差异有统计学意义(P<0.05)。两组年龄、性别、左右侧患肾、患肾合并结石及患肾功能受损比较,差异无统计学意义(P>0.05)。二分类Logistic回归分析示:诊断前口服抗生素及患肾积水是影响尿TB-DNA诊断肾结核阳性率的影响因素。结论患者年龄、性别、左右侧患肾、患肾合并肾结石及患肾功能受损情况不是影响尿TB-DNA阳性检出率的因素;患肾积水及口服抗生素是影响肾结核患者尿TB-DNA阳性检出率的独立危险因素。