Effect and its significance of different antituberculosis time on the positive rate of different pathogens in surgical specimens

Abstract

Objective To explore the difference and clinical significance of positive rate of five kinds of etiological detection techniques in surgical pathological specimens with different duration of anti-tuberculosis before operation.

Methods Totally 282 extrapulmonary tuberculosis patients who accepted standardization of anti-tuberculosis discharged from Wuhan Pulmonary Hospital during 2017 were divided into five groups according to antituberculosis time before Surgical sampling: 0 -<7 d, 7 -<14 d, 14 -<28 d , 28-<60 d, and ≥60 d. The results of acid-fast staining smear (AFB), real-time fluorescent quantitative PCR (TB-DNA), real-time fluorescence detection by constant temperature amplification of RNA (SAT- TB), GeneX-pert MTB / RIF (X-pert), tuberculosis culture (CTB) were retrospectively analyzed.

Results Based on comprehensive clinical diagnosis, the total positive rate of etiology in 282 surgical specimens was 89.36% (252 / 282). The sensitivity of five detection techniques were: X-pert 89.36%, TB-DNA 78.01%, SAT-TB 39.72%, CTB 15.25%, AFB 14.18%. With CTB as the gold standard, the negative predictive value of SAT-TB was 92.35% (157 / 170). The coincidence rate of X- Pert and CTB was 100.00%.Inter-group comparison: CTB positive rate had no significant difference within 0-28 days, but were significantly higher than those after 60 days ( P<0.001). There was no significant difference in the other four detection techniques in each time period.Intra-group comparison: The positive rate of X-pert in each group was significantly higher than that of AFB, SAT-TB and CTB ( P<0.001), and no significant difference in TB-DNA. All the TB-DNA groups were significantly higher than AFB, CTB and SAT-TB ( P<0.05). There was no statistical difference between CTB and AFB in each group ( P>0.05). After 28 days of anti-tuberculosis, the positive rate of CTB was significantly lower than that of SAT-TB ( P< 0.001).

Conclusion The positive rates of 5 pathogenic detection techniques in surgical pathological tissue samples with different antituberculosis duration were significantly different. Routine X-pert and CTB examination within 0-28 days of normative anti-tuberculosis is conducive to the diagnosis and treatment of tuberculosis.The positive of X-pert, TB-DNA, SAT- TB and AFB are not suitable as a single index for evaluating therapeutic effect, but SAT-TB can be used as a negative predictor of CTB.

Abstract

摘要： 目的 探讨不同抗结核时长的手术病理标本 5 种病原学检测技术阳性率差异及临床意义。 方法 对 2017 年在武汉市肺科医院外科经规范抗结核共 282 例肺外结核患者按手术取材前抗结核时间不同分为 0~<7 d、7~<14 d、14~<28 d、28~<60 d 和≥60 d 共 5 组, 对各组采用抗酸染色涂片 (AFB)、实时荧光定量 PCR (TB-DNA)、RNA 恒温扩增实 时荧光检测 (SAT-TB)、GeneX-pert MTB/RIF (X-pert)、结核培养 (CTB) 等 5 种方法进行病原学检查, 并对结果进行分析。 结果 以临床诊断为标准, 282 例手术标本病原学总阳性率为 89.36% (252/282) , X-pert、TB-DNA、SAT-TB、CTB 和 AFB 阳性率分别为 89.36%、78.01%、39.72%、15.25% 和 14.18%; 以 CTB 为金标准, SAT-TB 的阴性预测值为 92.35%(157/170); X-pert 与 CTB 判定 RFP 耐药吻合率为 100.00%。组间相同检查比较：CTB 在 0~<28 d 内阳性率无明显差异, 但均显著高 于≥60 d 患者 ( P<0.001) , 其余 4 种方法各时间段内比较均无明显差异。组内不同检查间比较：X-pert 阳性率在各组内 均显著高于 AFB、SAT-TB、CTB ( P<0.001) , 但与 TB-DNA 比较无统计学差异; TB-DNA 各组内均显著高于 AFB、CTB、SAT-TB ( P<0.05) ; 各组内 CTB 与 AFB 均无统计学差异 ( P>0.05) ; 28 d 后 CTB 阳性率均明显低于 SAT-TB ( P<0.001) 。 结论 不同抗结核时长的手术病理组织标本中 5 种病原学检测技术阳性率差异较大, 规范抗结核 0~28 d 内常规送检 X-pert、CTB 有利于结核病的诊断和治疗, X-pert、TB-DNA、SAT-TB、AFB 阳性均不宜作为疗效评估的单一指标, 而 SAT-TB 可作为 CTB 阴性的预测指标。