【摘要】 目的探究常用的4种检测方法联合应用对痰菌阴性肺结核的诊断价值。方法选取58例痰菌阴性肺结核及22例其他肺部疾病患者,均取气管肺泡灌洗液,依次进行Xpert MTB/RIF系统、改良抗酸染色法、BDBECTEC 960快速全自动结核菌培养系统及TB-PCR检测,分析4种检测方法联合应用对痰菌阴性肺结核的诊断效能。结果 4种方法单独检测阳性率依次为Xpert MTB/RIF检测(93.10%)>BDBECTEC 960法(91.38%)>TB-PCR检测(75.86%)>改良抗酸染色法(68.97%),4种方法联合检测阳性率达96.55%,高于各方法单独检测,且联合检测诊断痰菌阴性肺结核的灵敏度最高为96.55%,曲线下面积(AUC)为0.93,诊断效能最高,但4种方法联合检测增加了假阳性率,且与Xpert MTB/RIF检测、BDBECTEC 960法单独检测诊断效能接近。结论 Xpert MTB/RIF系统、改良抗酸染色法、BDBECTEC 960法及TB-PCR四者联合检测对于提高痰菌阴性肺结核的诊断效能价值不大,建议采用Xpert MTB/RIF系统或BDBECTEC 960法联合检测诊断为宜。更多还原

【Abstract】 Objective To explore the diagnostic value of the combined application of four commonly used detecting methods for sputum-negative pulmonary tuberculosis. Methods For the selected 58 patients with sputum-negative pulmonary tuberculosis and 22 ones with other pulmonary diseases, the bronchoalveolar lavage fluid was taken. Xpert MTB/RIF system, improved acid-fast staining method, BDBECTEC 960 rapid full-automatic tuberculosis culture system and TB-PCR detection were carried out sequentially. The diagnostic efficacy of the combined application of the four detecting methods for sputum-negative pulmonary tuberculosis was analyzed. Results The positive rates of the four detecting methods were respectively Xpert MTB/RIF test(93.10%), BDBECTEC 960 test(91.38%), TB-PCR test(75.86%) and improved acid-fast staining method(68.97%). The positive rate of the combined application of the four detecting methods were 96.55%, higher than that of each method used separately; the sensitivity of the combined detection for sputum-negative pulmonary tuberculosis was 96.55%, the area under curve(AUC) was 0.93, and the diagnostic efficiency was the highest. However, the false positive rate increased for the combined detection of the four detecting methods, which was close to that of Xpert MTB/RIF and BDBECTEC 960 when they were adopted separately. Conclusion The combined detection of Xpert MTB/RIF system, improved acid-fast staining method, BDBECTEC 960 method and TB-PCR method is of little value in improving the diagnostic efficiency of sputum-negative pulmonary tuberculosis. It is suggested that the combined detection of Xpert MTB/RIF system or BDBECTEC 960 method should be used in the diagnosis of sputum-negative pulmonary tuberculosis.更多还原