CAJ | 학술논문

目的探讨显微镜观察药物敏感度检测技术(MODS)对肺外结核的诊断价值.方法采用24孔细胞培养板液体培养方法建立MODS.收集74份结核性胸膜炎患者的胸腔积液、63份结核性脑膜炎患者的脑脊液和18份非结核病患者胸腔积液和脑脊液标本,分别采用抗酸染色法、改良罗氏培养法和MODS进行结核分枝杆菌检测,对改良罗氏培养法和MODS培养获得的分枝杆菌采用免疫层析法鉴定,数据比较采用x2检验.结果 MODS、改良罗氏培养法和抗酸染色法检测结核性胸膜炎的阳性率分别为58.1％(43/74)、18.9％(14/74)和6.8％(5/74);检测结核性脑膜炎的阳性率分别为54.0％(34/63)、20.6％(13/63)和4.8％(3/63).MODS检测结核性胸膜炎和结核性脑膜炎的阳性率均高于改良罗氏培养法,差异有统计学意义(x2=24.00,P＜0.01；x2=14.97,P＜0.01).所有改良罗氏培养法和MODS检测获得的分枝杆菌均为结核分枝杆菌.三种方法检测18份非结核病患者胸腔积液和脑脊液结果均为阴性.MODS检测脑脊液和胸腔积液标本的阳性检出中位时间分别为9d和14d,明显短于改良罗氏培养法所需的31d.结论 MODS与传统病原学检测方法相比,具有敏感性好、检出时间短的优势,适用于肺外结核病的临床快速诊断.
목적 탐토현미경관찰약물민감도검측기술(MODS)대폐외결핵적진단개치.방법 채용24공세포배양판액체배양방법건립MODS.수집74빈결핵성흉막염환자적흉강적액、63빈결핵성뇌막염환자적뇌척액화18빈비결핵병환자흉강적액화뇌척액표본,분별채용항산염색법、개량라씨배양법화MODS진행결핵분지간균검측,대개량라씨배양법화MODS배양획득적분지간균채용면역층석법감정,수거비교채용x2검험.결과 MODS、개량라씨배양법화항산염색법 검측결핵성흉막염적양성솔분별위58.1％(43/74)、18.9％(14/74)화6.8％(5/74);검측결핵성뇌막염적양성솔분별위54.0％(34/63)、20.6％(13/63)화4.8％(3/63).MODS검측결핵성흉막염화결핵성뇌막염적양성솔균고우개량라씨배양법,차이유통계학의의(x2=24.00,P＜0.01；x2=14.97,P＜0.01).소유개량라씨배양법화MODS검측획득적분지간균균위결핵분지간균.삼충방법검측18빈비결핵병환자흉강적액화뇌척액결과균위음성.MODS검측뇌척액화흉강적액표본적양성검출중위시간분별위9d화14d,명현단우개량라씨배양법소수적31d.결론 MODS여전통 병원학검측방법상비,구유민감성호、검출시간단적우세,괄용우폐외결핵병적림상쾌속진단.
Objective To investigate the diagnostic value of microscopic observation drug susceptibility assay (MODS) in extrapulmonary tuberculosis. Methods MODS technology was constructed by using 24-well cell culture plate and liquid culture.Ziehl-Neelsen smear,Lowenstein-Jensen culture and MODS were used to detect Mycobacterium tuberculosis in 74 pleural fluid samples collected from patients with tuberculous pleurisy,63 cerebrospinal fluid samples collected from patients with tuberculous meningitis and 18 samples collected from non-tuberculosis suspects.The immunochromatography was used to distinguish Mycobacterium tuberculosis from nontuberculosis mycobacteria. The results of Ziehl-Neelsen smear, Lowenstein-Jensen culture and MODS were compared by x2 test.Results The positive rates of MODS,Lowenstein-Jensen culture and Ziehl-Neelsen smear were 58.1 ％ (43/74),18.9 ％ (14/74 ) and 6.8％ (5/74),respectively in tuberculous pleurisy patients; 54.0％(34/63),20.6％ (13/63) and 4.8％ (3/63),respectively in tuberculous meningitis patients.The positive rate of MODS technology was significantly higher than that of Lowenstein Jensen culture in tuberculous pleurisy patients (x2 =24.00,P＜0.01) and tuberculous meningitis patients (x2 =14.97,P ＜ 0.01). Each Mycobacterium obtained from MODS and Lowenstein-Jensen culture was identified as Mycobacterium tuberculosis by immunochromatography.All of the 18 pleural fluid and cerebrospinal fluid samples which collected from non-tuberculosis suspects were all negative detected by Ziehl-Neelsen smear,Lowenstein-Jensen culture and MODS.The median time to culture positive of MODS was 9 days in cerebrospinal fluid and 14 days in pleural fluid samples,which were both significantly shorter than that of Lowenstein-Jensen culture (31 days in both cerebrospinal fluid and pleural fluid samples). Conclusion Compared to conventional microbiological diagnosis methods,MODS is a rapid detection method of Mycobacterium tuberculosis with a higher positive detection rate,which is suitable for rapid diagnosis of extrapulmonary tuberculosis.