Objective To explore the difference and significance of the positive rates of five kinds of pathogenic examinations in tuberculous pathological tissues and airway secretions.
Methods A total of 166 cases of tuberculosis diagnosed surgically in the Department of Surgery, Wuhan Pulmonary Hospital from January 1, 2017 to December 31, 2017, combined with pulmonary tuberculosis received airway secretion examination were enrolled into this study. According to the origin of the specimens, they are divided into two groups: the etiological examination group of surgical specimens (surgical specimen group) and the etiological examination group of airway secretion specimens (airway secretion specimen group). The results of acid fast bacilli (AFB), real-time fluorescence quantitative PCR (TB-DNA), real-time fluorescent RNA isothermal amplification detection technology (simultaneous amplification and testing of Mycobacterium tuberculosis, SAT-TB), Gene-Xpert/ RIF (X-pert), tuberculosis culture (CTB) were retrospectively analyzed.
Results Taking clinical diagnosis as the criterion, the total positive rates of pathological and airway secretions were 86.14% and 21.08%, respectively; the positive rates of X-pert were 85.89% and 29.76%%, respectively. The positive rates of the five examinations in the two groups was consistent from high to low, in the following order: X-pert, TB-DNA, SAT-TB, CTB and AFB. Taking the results of surgical specimens as diagnostic criteria, the results of airway secretion specimens were poorly consistent with those of surgical specimens ( Kappa< 0.4). The positive rates of the five examinations were significantly lower than those of surgical specimens (McNemer test, all P< 0.05).
Conclusion The positive rate of tuberculosis-related pathogens in pathological tissue specimens is significantly higher than that in airway secretion specimens. Clinically, we should pay attention to the detection of X-pert, CTB and other examination methods in pathological tissue specimens of bacterium-negative pulmonary tuberculosis patients.
摘要： 目的 探讨5种病原学检查在结核性病理组织及气道分泌物标本中的阳性率差异及意义。 方法收集2017年武汉市肺科医院外科经手术确诊结核合并肺结核且接受气道分泌物检查的166份病例的结核病原学检查结果，根据标本来源不同分为手术标本病原学检查组(简称手术标本组)与气道分泌物标本病原学检查组(简称气道分泌物标本组),对抗酸染色涂片(AFB)、实时荧光定量PCR(TB-DNA)、RNA恒温扩增实时荧光检测(SAT-TB)、Gene-X-pert/RIF(X-pert)、结核培养(CTB)等结果进行回顾分析。 结果以临床诊断为标准，手术标本组和气道分泌物标本组总阳性率分别为86.14%、21.08%,X-per阳性率分别为85.89%、29.76%;两组的五种检测技术阳性率由高到低排序一致，均为X-pert、TB-DNA、SAT-TB、CTB、AFB；以手术标本结果为诊断标准，气道分泌物标本结果与其一致性均较差( Kappa<0.4),五种检查阳性率均低于手术标本，且差异具有统计学意义(McNemer检验, P<0.05)。 结论病理组织标本结核病原学阳性率高于气道分泌物标本，临床应重视对菌阴肺结核患者的病理组织标本进行X-pert、CTB等检查。