【摘要】 目的 评估线性探针技术在骨关节结核快速诊断中的应用价值。方法 回顾性纳入新疆维吾尔自治区胸科医院骨科2014年1月至2017年2月接受病灶清除手术的157例疑似骨关节结核患者,同时采用线性探针技术、结核分枝杆菌培养及抗酸染色对病灶组织(均为术中切除病灶组织)进行检测。以临床诊断为金标准,计算线性探针技术检测结核分枝杆菌的敏感度、特异度,并结合药物敏感性试验(简称“药敏试验”)结果评价线性探针技术在骨关节结核快速诊断中的应用价值。结果 157例患者中127例临床确诊为骨关节结核,30例为非骨关节结核。线性探针技术、结核分枝杆菌培养及抗酸染色检测手术切除病灶组织的敏感度分别为76.38%(97/127)、55.12%(70/127)、37.01%(47/127),差异有统计学意义(χ~2=40.06,P<0.05);特异度分别为73.33%(22/30)、76.67%(23/30)、93.33%(28/30),差异无统计学意义(χ~2=4.50,P=0.11)。与结核分枝杆菌培养及药敏试验相比较,157例患者中,培养+药敏试验10例检测为耐药菌株,线性探针技术也检测出10例耐药菌株,患者与上述10例相同。其中,4例对异烟肼耐药,线性探针技术检测结果均为对异烟肼单耐药;1例对利福平耐药,线性探针技术检测为对异烟肼、利福平同时耐药;其余5例为耐多药结核病,线性探针技术检测结果均为对异烟肼、利福平同时耐药。结论 线性探针技术检测病灶组织中结核分枝杆菌的敏感度高、耗时短,且可同时检测样本中的结核分枝杆菌是否对异烟肼、利福平耐药,对骨关节结核快速诊断及耐药结核病的早期筛查有较好的临床应用价值。更多还原

【Abstract】 Objective To evaluate the application value of line probe assay(LPA)for rapid diagnosis in patients with osteoarticular tuberculosis.Methods We analyzed retrospectively data including LPA,mycobacterium culture and Acid-fast bacillus(AFB)staining detected with resection lesion in 157 patients with osteoarticular tuberculosis admitted in the Chest Hospital of Xinjiang Uyghur Autonomous Region during Jan.2014 and Feb.2017.The sensitivity,specificity and drug susceptibility testing(DST)were calculated and to evaluate application value of this technique according to the diagnostic standard.Results Of 157 patients,127 patients were diagnosed definitely with osteoarticular tuberculosis and 30 patients were diagnosed definitely with non-osteoarticular tuberculosis.The sensitivity of LPA,mycobacterium culture and AFB were 76.38%(97/127),55.12%(70/127)and 37.01%(47/127)with significant difference statistically(χ~2=40.06,P<0.05).However,the specificity of LPA,mycobacterium culture and AFB were 73.33%(22/30),76.67%(23/30)and 93.33%(28/30)without significant difference statistically(χ~2=4.50,P=0.11).Of 157 patients,10 patients were detected as drug resistance by DST and LPA simultaneously.Except for one case,the results of drug resistance detected by DST and LPA were identical including isoniazid in 4 cases and multidrug-resistant tuberculosis(MDR-TB)in 5 cases.The one case was detected rifampicin resistance by DST and MDR-TB by LPA. Conclusion LPA has high sensitivity and short time-consuming and simultaneous detection the drug resistance of isoniazid and rifampicin in the sample.It has better clinical application value in earlier diagnosis and drug resistance screening in patients with osteoarticular tuberculosis.更多还原