Objective To explore the difference and clinical significance of five etiological detection techniques in the tuberculosis positive rate of pathological specimens obtained by different taking materials method.
Methods The results of etiological examination of tuberculosis in 345 cases of operated and clinically confirmed tuberculosis in Wuhan Pulmonary Hospital in 2017 were collected. The samples were taken in different ways as grouping basis. The results of acid-fast staining smears (AFB), real-time fluorescence quantitative PCR (TB-DNA), RNA constant temperature amplification real-time fluorescence detection (SAT-TB), Gene-X-pert/RIF and tuberculosis culture(CTB) were analyzed retrospectively in each group.
Results There are four commonly used methods to obtain specimens, namely 345 cases of operation, 55 cases of puncture, 37 cases of abscess excision (abbreviated as excision) and 7 cases of secretion collection.Based on clinical diagnosis, the total positive rates of etiology in surgical, puncture, excision and secretion rates were 86.38%, 85.45%, 100.00%, 85.71%; X-pert were 86.26%, 83.33%, 100.00% and 85.71%. The sensitivity of the five detection techniques ranged from high to low, and the first two in each group were X-pert and TB-DNA, the lowest was AFB. With the results of surgical specimens as diagnostic criteria, although the positive rates of CTB in excision and puncture specimens were higher than those in surgical specimens, the consistency was medium ( K=0.521, 0.530), there was no significant difference in the positive rates of five pathogens (McNemer test, P>0.05).
Conclusion The detection rate of five kinds of tuberculosis etiological detection techniques in pathological specimens is not related to the taking materials method. It is advocated that early detection of X-Pert and CTB for precise puncture of the lesion is helpful for early diagnosis and treatment of the disease.
摘要： 目的 探讨五种病原学检测技术在不同取材方法获取的病理标本中结核阳性率的差异及其临床意义。 方法 收集2017年武汉市肺科医院外科手术并临床确诊结核的345份病例的结核病原学检查结果, 以标本取材方式 不同为分组依据, 对各组抗酸染色涂片(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 以临床常用的四种方法获取标本, 分别为手 术345例、穿刺55例、脓肿切排(简称切排)37例和收集分泌物7例。以临床诊断为标准, 手术、穿刺、切排和收集分泌物 获取的标本病原学总阳性率分别为86.38%、85.45%、100.00%、85.71%;X-pert阳性率分别为86.26%、83.33%、100.00%、 85.71%, 五种检测技术灵敏度由高到低排序各组前两名均为X-pert、TB-DNA, 最低均为AFB;以手术标本结果为诊断 标准, 虽切排和穿刺标本CTB阳性率均高于手术标本, 一致性均为中等( K=0.521、0.530), 但五种病原学阳性率比较差 异均无统计学意义(McNemer检验, P>0.05)。结论病理标本中五种结核病原学检测技术检出率均与取材方法无关, 提倡早期对病灶精准穿刺行X-pert、CTB检查以利于疾病的早期诊断和治疗。