支气管镜检查联合痰TB-RNA、血清TB-SA检测诊断菌阴肺结核

doi:10.3969/j.issn.1673-8640.2023.09.011

摘要/Abstract

摘要：

目的探讨支气管镜检查联合痰结核分枝杆菌RNA（TB-RNA）、血清结核分枝杆菌特异性蛋白抗体（TB-SA）检测诊断菌阴肺结核的效能。方法选取2018年10月—2019年10月淮安市第四人民医院经痰结核分枝杆菌（MTB）培养确诊的菌阴肺结核患者104例（观察组），以同期80例肺部感染非肺结核患者作为对照组。对所有患者行支气管镜检查。采集所有患者痰样本和血液样本，进行痰TB-RNA和血清TB-SA检测。分析3种方法诊断菌阴肺结核的效能。结果观察组支气管镜检查阳性率（62.50%）显著高于对照组（32.0%），痰TB-RNA检测阳性率（78.85%）显著高于对照组（22.50%），血清TB-SA检测阳性率（68.27%）显著高于对照组（20.00%），差异均有统计学意义（P<0.05）。3种方法联用，诊断肺结核的敏感性显著高于单独支气管镜检查（P<0.001）、TB-RNA检测（P=0.037）和TB-SA检测（P<0.001）；准确性显著高于单独支气管镜检查（P<0.001）、TB-RNA检测（P=0.028）和TB-SA检测（P<0.001）；特异性差异无统计学意义（P>0.05）。结论支气管镜检查联合痰TB-RNA、血清TB-SA检测可有效提高诊断菌阴肺结核的敏感性。

关键词: 支气管镜检查, 结核分枝杆菌RNA, 结核分枝杆菌特异性蛋白抗体, 菌阴肺结核, 诊断

Abstract:

Objective To investigate the efficiency of bronchoscopy combined with sputum Mycobacterium tuberculosis RNA（TB-RNA） and serum Mycobacterium tuberculosis specific antigen（TB-SA） determinations for the diagnosis of negative pulmonary tuberculosis. Methods A total of 104 patients with bacterial-negative pulmonary tuberculosis diagnosed by sputum Mycobacterium tuberculosis（MTB） culture in Huai'an Fourth People's Hospital from October 2018 to October 2019 were enrolled as observation group，and 80 patients with non-pulmonary tuberculosis during the same period were enrolled as control group. Bronchoscopy was performed，sputum samples were collected to determine sputum TB-RNA and serum TB-SA in sputum samples，and the diagnostic efficiency of each determination method for bacterial-negative pulmonary tuberculosis was evaluated. Results The positive rate of bronchoscopy in observation group（62.50%） was higher than that in control group（32.0%）（P<0.05）. The positive rate of sputum TB-RNA in observation group（78.85%） was higher than that in control group（22.50 %）（P<0.05）. The positive rate of serum TB-SA in observation group （68.27%）was higher than that in control group（20.00%）（P<0.05）. The sensitivity of the combined determination of the 3 methods was higher than those of bronchoscopy（P<0.001），TB-RNA determination（P=0.037） and TB-SA determination（P<0.001）. The accuracy of the combined determination of the 3 methods was higher than those of bronchoscopy（P<0.001），TB-RNA determination（P=0.028） and TB-SA determination（P<0.001）. There was no statistical significance in the specificity of the combined determination of the 3 methods（P>0.05）. Conclusions Bronchoscopy combined with sputum TB-RNA and serum TB-SA can effectively improve the sensitivity for the diagnosis of bacterial-negative pulmonary tuberculosis，which provides a determination method for the clinical diagnosis of bacterial-negative pulmonary tuberculosis，with high clinical application value.

Key words: Bronchoscopy, Mycobacterium tuberculosis RNA, Mycobacterium tuberculosis specific antibody, Bacterial-negative pulmonary tuberculosis, Diagnosis

中图分类号:

R378.91

孙信林, 叶星明, 李倩, 赵丽君. 支气管镜检查联合痰TB-RNA、血清TB-SA检测诊断菌阴肺结核[J]. 检验医学, 2023, 38(9): 870-873.

SUN Xinlin, YE Xingming, LI Qian, ZHAO Lijun. Bronchoscopy combined with sputum Mycobacterium tuberculosis ribonucleic acid and serum Mycobacterium tuberculosis specific antibody determinations for diagnosis of negative pulmonary tuberculosis[J]. Laboratory Medicine, 2023, 38(9): 870-873.

图/表 4

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组别	例数	阳性/[例（%）]	阴性/[例（%）]
观察组	104	65（62.50）	39（37.50）
对照组	80	26（32.50）	54（67.50）
χ²值		16.280
P值		<0.001

组别	例数	阳性/[例（%）]	阴性/[例（%）]
观察组	104	65（62.50）	39（37.50）
对照组	80	26（32.50）	54（67.50）
χ²值		16.280
P值		<0.001

组别	例数	阳性/[例（%）]	阴性/[例（%）]
观察组	104	82（78.85）	22（21.15）
对照组	80	18（22.50）	62（77.50）
χ²值		57.862
P值		<0.001

组别	例数	阳性/[例（%）]	阴性/[例（%）]
观察组	104	82（78.85）	22（21.15）
对照组	80	18（22.50）	62（77.50）
χ²值		57.862
P值		<0.001

组别	例数	阳性/[例（%）]	阴性/[例（%）]
观察组	104	71（68.27）	33（31.73）
对照组	80	16（20.00）	64（80.00）
χ²值		42.266
P值		<0.001