临床荟萃
臨床薈萃
림상회췌
CLINICAL FOCUS
2014年
6期
608-610,611
,共4页
结核,肺%分枝杆菌,结核%涂片%培养%核酸恒温扩增%抗体
結覈,肺%分枝桿菌,結覈%塗片%培養%覈痠恆溫擴增%抗體
결핵,폐%분지간균,결핵%도편%배양%핵산항온확증%항체
tuberculosis,pulmonary%sputum smear%culture%simultaneous amplification and testing%antibodies
目的：评估直接涂片法、浓集涂片法、结核分枝杆菌罗氏培养法、BACTEC MGIT960系统培养结核分枝杆菌法、实时荧光定量聚合酶链反应（PCR）、实时荧光核酸恒温扩增检测技术（SAT）扩增法、结核分枝杆菌 IgG抗体检测等7种方法对临床结核诊断的应用价值。方法对临床确诊的672例肺结核患者和62例健康体检者的痰标本用7种结核菌检测方法进行检测。结果672例患者中检测阳性率分别为直接涂片法17．0％（115/676）、浓集涂片法25．6％（173/676）、改良罗氏培养法32．2％（218/676）、BACTEC MGIT960系统培养结核分枝杆菌法45．7％（309/676）、实时荧光定量 PCR 90．1％（609/676）、SAT 扩增法96．4％（652/676）、结核分枝杆菌 IgG 抗体检测法65．4％（442/676）。对照组只有荧光PCR法和结核抗体法检出阳性，阳性率分别为8．1％、12．9％。涂阴标本经罗氏培养法＋结核抗体法＋SAT法联合检出阳性率高于单一检测方法。结论涂片法操作简便、快速和价格便宜，但阳性率低，在长时期内其依然是基层医院诊断结核病的主要检测手段；结核分支杆菌培养能进行菌种鉴定和药物敏感试验仍是不可缺少的方法，但周期长；结核抗体法方便，简单，仍是结核实验室诊断的重要手段，但不能区分感染与发病；荧光PCR扩增法快速，灵敏，有较好诊断价值，但设备昂贵，技术要求高，易污染；SAT法快速，灵敏，要求较荧光 PCR扩增法低，可以辅助诊断结核病。同时联合检测提高诊断率，并满足不同临床需要。
目的：評估直接塗片法、濃集塗片法、結覈分枝桿菌囉氏培養法、BACTEC MGIT960繫統培養結覈分枝桿菌法、實時熒光定量聚閤酶鏈反應（PCR）、實時熒光覈痠恆溫擴增檢測技術（SAT）擴增法、結覈分枝桿菌 IgG抗體檢測等7種方法對臨床結覈診斷的應用價值。方法對臨床確診的672例肺結覈患者和62例健康體檢者的痰標本用7種結覈菌檢測方法進行檢測。結果672例患者中檢測暘性率分彆為直接塗片法17．0％（115/676）、濃集塗片法25．6％（173/676）、改良囉氏培養法32．2％（218/676）、BACTEC MGIT960繫統培養結覈分枝桿菌法45．7％（309/676）、實時熒光定量 PCR 90．1％（609/676）、SAT 擴增法96．4％（652/676）、結覈分枝桿菌 IgG 抗體檢測法65．4％（442/676）。對照組隻有熒光PCR法和結覈抗體法檢齣暘性，暘性率分彆為8．1％、12．9％。塗陰標本經囉氏培養法＋結覈抗體法＋SAT法聯閤檢齣暘性率高于單一檢測方法。結論塗片法操作簡便、快速和價格便宜，但暘性率低，在長時期內其依然是基層醫院診斷結覈病的主要檢測手段；結覈分支桿菌培養能進行菌種鑒定和藥物敏感試驗仍是不可缺少的方法，但週期長；結覈抗體法方便，簡單，仍是結覈實驗室診斷的重要手段，但不能區分感染與髮病；熒光PCR擴增法快速，靈敏，有較好診斷價值，但設備昂貴，技術要求高，易汙染；SAT法快速，靈敏，要求較熒光 PCR擴增法低，可以輔助診斷結覈病。同時聯閤檢測提高診斷率，併滿足不同臨床需要。
목적：평고직접도편법、농집도편법、결핵분지간균라씨배양법、BACTEC MGIT960계통배양결핵분지간균법、실시형광정량취합매련반응（PCR）、실시형광핵산항온확증검측기술（SAT）확증법、결핵분지간균 IgG항체검측등7충방법대림상결핵진단적응용개치。방법대림상학진적672례폐결핵환자화62례건강체검자적담표본용7충결핵균검측방법진행검측。결과672례환자중검측양성솔분별위직접도편법17．0％（115/676）、농집도편법25．6％（173/676）、개량라씨배양법32．2％（218/676）、BACTEC MGIT960계통배양결핵분지간균법45．7％（309/676）、실시형광정량 PCR 90．1％（609/676）、SAT 확증법96．4％（652/676）、결핵분지간균 IgG 항체검측법65．4％（442/676）。대조조지유형광PCR법화결핵항체법검출양성，양성솔분별위8．1％、12．9％。도음표본경라씨배양법＋결핵항체법＋SAT법연합검출양성솔고우단일검측방법。결론도편법조작간편、쾌속화개격편의，단양성솔저，재장시기내기의연시기층의원진단결핵병적주요검측수단；결핵분지간균배양능진행균충감정화약물민감시험잉시불가결소적방법，단주기장；결핵항체법방편，간단，잉시결핵실험실진단적중요수단，단불능구분감염여발병；형광PCR확증법쾌속，령민，유교호진단개치，단설비앙귀，기술요구고，역오염；SAT법쾌속，령민，요구교형광 PCR확증법저，가이보조진단결핵병。동시연합검측제고진단솔，병만족불동림상수요。
Objective To compare the application value of sputum smear,sputum float-concentrated,L-J sputum culture,BACTCEC MGIT960 systemic culture,polymerase chain reaction(PCR),simutanenous amplificationg and testing(SAT)and antibody IgG to Mycobacterium tuberculosis (TB-Ab)in clinical diagnosis of tuberculosis(TB). Methods Sputum samples from 672 tuberculosis patients and 62 healthy persons from our hospital were detected by sputum smear,sputum float-concentrated,L-J sputum culture,BAC-TCEC MGIT960 systemic culture,PCR,SAT and TB-Ab.Results Totally 672 tuberculosis patients were submitted with a total positive rate of 17.0%(115/676)in sputum smear,25.6%(173/676)in sputum float-concentrated,32.2%(218/676)in L-J sputum culture,45.7%(309/676)in BACTCEC MGIT960 systemic culture,90.1%(609/676)in PCR,96.4%(652/676)in SAT and 65.4%(442/676)in TB-Ab.In 62 healthy persons,only PCR and TB-Ab were submitted with positive rate of 8.1%,12.9%respectively.Smear-negative specimens of positive rate by L-J sputum culture tuberculosis,TB-Ab and SAT combined detection were higher than that of single detection method.Conclusion Sputum smear is simple,fast and cheap,but the positive rate is low.Sputum smear is the leading role of basic-level hospitals for a long period of time.L-J sputum culture to bacteria identification and drug sensitive tests are still indispensable method,but the cycle is long. Mycobacterium tuberculosis is simple,convenient.It is still an important means of laboratory diagnosis of TB,but cannot distinguish between infection and disease.PCR is fast,sensitive and has a good diagnostic value,but the equipment of PCR is expensive.PCR requires high technology and is polluted easily.The SAT is fast,sensitive,too. STA that requires less cost and lower technique than PCR will help the diagnosis of tuberculosis.Joint detection helps improve diagnosis rate and meets the clinical needs.
