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.
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。