[1]王铁山,齐墨词.比较四种实验室辅助检查方法在肺结核诊断中的应用价值[J].现代检验医学杂志,2016,31(01):134-137.[doi:10.3969/j.issn.1671-7414.2016.01.039]
　WANG Tie-shan,QI Mo-ci.A Comparative Study on Four Methods in the Diagnosis of Tuberculosis[J].Journal of Modern Laboratory Medicine,2016,31(01):134-137.[doi:10.3969/j.issn.1671-7414.2016.01.039]
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比较四种实验室辅助检查方法在肺结核诊断中的应用价值()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第31卷
期数:
2016年01期
页码:
134-137
栏目:
研究简报·实验技术
出版日期:
2016-01-25

文章信息/Info

Title:
A Comparative Study on Four Methods in the Diagnosis of Tuberculosis
作者:
王铁山; 齐墨词
首都医科大学附属北京友谊医院临床检验中心,北京 100050
Author(s):
WANG Tie-shan; QI Mo-ci
Clinical Laboratory Center, Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China
关键词:
结核感染T淋巴细胞斑点试验;  聚合酶链反应;  抗结核抗体;  抗酸染色;  肺结核
分类号:
R521; R446
DOI:
10.3969/j.issn.1671-7414.2016.01.039
文献标志码:
A
摘要:
目的 评价结核感染T淋巴细胞斑点试验(T-SPOT)、荧光PCR、抗结核抗体试验、抗酸染色四种辅助检查方法对于肺结核诊断的应用价值。方法 回顾性分析2012年1月～2014年12月期间530例同时进行上述四项检查的病例,以临床诊断为金标准,计算四种方法的敏感度、特异度、阳性预测值、阴性预测值、Kappa值、约登指数、阳性似然比、阴性似然比等指标,进行四种检测方法之间的配对χ2检验。结果 T-SPOT敏感度95.90%,误诊率14.33%,阴性预测值97.29%,约登指数0.82,均为最高,阴性似然比0.05为最低; PCR漏诊率87.18%为最高; 抗结核抗体阳性似然比6.48为最低; 抗酸染色特异度99.70%,阳性预测值98.90%,阳性似然比153.83均为最高。四种方法间两两比较差异均有统计学意义。结论T-SPOT和抗酸染色可作为重要的辅助检查,抗结核抗体具有高时效的特点,而PCR方法更适用于无菌部位体液的检查。
Abstract:
Objective To evaluate the value of four methodsin diagnosis of pulmonary tuberculosis,including T-SPOT,fluorescent PCR,anti-TB antibody test,and acid-fast staining.Methods Retrospective analysis of 530 cases between January 2012 and December 2014 who hadtaken four methods,and calculated the sensitivity specificity,positive predictive value,negative predictive value,Kappa value,Youden index,positive likelihood ratio,negative likelihood ratio,Paired χ2 test.Consider clinicaldiagnosis as the gold standard.Results The sensitivity,negative predictive value,Youden index of T-SPOT were 95.90%,97.29%,0.82,respectively,and all of these were the highest.The negative likelihood ratio of T-SPOT was 0.05,which was the lowest.Misdiagnosis rate of PCR was 87.18%,which was the highest.Positive likelihood of anti-TB antibody test was thelowest,6.48,while other indicators were no advantage.The specificity,positive predictive value and positive likelihood ratio of acid-fast staining were 99.70%,98.90%,153.83,respectively,and the three of these were highest.Pairwise comparison between the four methods were significantly different.Conclusion The T-SPOT and acid-fast staining can be used as important methods,and the anti-TB antibody can provide result quickly,and PCR method is more suitable for examination of sterile body fluids.

参考文献/References:

[1] 乐 军,梁 莉,李苏辉,等.酶联免疫斑点试验快速诊断结核分枝杆菌感染的临床应用价值[J].中华检验医学杂志,2006,29(11):1005-1008. Yue J,Liang L,Li SH,et al.Clinical application of enzyme-linkedimmunospot assay for rapid diagnosis of active tuberculosis[J].Chinese Journal of Laboratory Medicine,2006,29(11):1005-1008.
[2] Zhang LF,Liu XQ,Zuo LY,et al.Longitudinal observation of an interferon gamma-released assay(T-SPOT.TB)for Mycobacterium tuberculosis infection in AIDS patients on highly active antiretroviral therapy[J].Chin Med J(Engl),2010,123(9):1117-1121.
[3] Kim SH,Song KH,Choi SJ,et al.Diagnostic usefulness of a T-cell-based assay for extrapulmonary tuberculosis in immunocompmmised patients[J].Am JMed,2009,122(2):189-195.
[4] Farhat M,Greenaway C,Pai M,el al.False-positive tuberculin skin tests:what is the absolute effect of BCG and non-tuberculous mycobacteria?[J].Int J Tubere Lung Dis,2006,10(11):1192-1204.
[5] Ribeiro S,Dooley K,Hackman J,et al.T-SPOT.TB responses during treatment of pulmonary tuberculosis[J].BMC Infect Dis,2009,9(1):1-9.
[6] Adetifa IM,Ota MO,Jeffries DJ,et al.Interferon-γ ELISPOT as a biomarker of treatment efficacy in latent tuberculosis infection:a clinical trial[J].Am J Respir Crit Care Med,2013,187(4):439-445.
[7] 段 静,王 艳,袁 杭,等.结核杆菌五种实验室检测方法比较[J].现代检验医学杂志,2014,29(4):79-82. Duan J,Wang Y,Yuan H,et al.Comparison of Mycobacterium tuberculosis in five kinds of laboratory tests[J].Journal of Modern Laboratory Medicine,2014,29(4):79-82.
[8] 归巧娣,刘 珂,苍金荣,等.干扰素释放酶联免疫法(TB-IGRA)与蛋白芯片法检测结核分枝杆菌的方法比较[J].现代检验医学杂志,2014,29(5):114-116. Gui QD,Liu K,Cang JR,et al.Comparison of TB-IGRA and protein chip in the diagnosis of Mycobacterium tuberculosis[J].Journal of Modern Laboratory Medicine,2014,29(5):114-116.

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备注/Memo

备注/Memo:
作者简介:王铁山(1985-),男,硕士,医师,研究方向为细菌耐药性及感染性疾病诊断,Tel:010-63138577,E-mail:ironthree@163.com。
更新日期/Last Update: 2016-01-20