痰涂片和TB-DNA及血清抗PPD-IgG在肺结核感染诊断中的联合应用

摘要

目的 探讨痰 TB-DNA 定性与血清抗结核抗体及痰抗酸染色检测方法在肺结核感染诊断中的联合应用价值.方法 以2013年1月至2015年6月在清远市人民医院就诊的肺结核患者278例为研究对象.另择性别、年龄匹配的同期入院非肺结核病患者121例为对照组.现通过收集该肺结核患者的TB-DNA定性和血清抗结核抗体及抗酸染色的检测结果进行分析 ,探讨痰TB-DNA定性与血清抗结核抗体检测及抗酸染色在肺结核感染诊断中的联合应用.结果 结核病组中抗酸染色灵敏度为32 .01% ;血清抗结核抗体灵敏度为51 .44% ;TB-DNA定性灵敏度为48 .56% ;TB-DNA定性和血清抗结核抗体联合检出率为67 .63% ;TB-DNA定性和抗酸染色联合检出率为54 .68% ;血清抗结核抗体和抗酸染色联合检出率为57 .55% ;三者联合检出率为68 .71% .结论 血清抗结核抗体检测对肺结核的诊断简单、有效 ,灵敏度优于TB-DNA定性检测及抗酸染色 ,但其特异度比较低.细菌学诊断是结核病诊断的"金标准" ,但是痰涂片寻找抗酸杆菌的阳性率低 ,而 TB-DNA定性检测快速又准确.血清抗结核抗体及痰抗酸染色及痰TB-DNA定性检测联合应用于肺结核诊断效果更佳.%Objective To explore the value of combined application of qualitative detection of TB-DNA serum anti-PPD-IgG and acid-fast staining methods in the diagnosis of tuberculosis infection .Methods Totally 278 pulmonary tuberculosis patients and 121 non-pulmonary tuberculosis patients were collected from Qingyuan people′s hospital during the period from January 2013 to June 2015 .Tuberculosis in patients with TB-DNA qualitative and serum anti-PPD-IgG and acid-fast staining test results was analyzed . Sputum TB-DNA qualitative and serum anti-PPD-IgG detection and joint application of acid-fast staining in the diagnosis of tuber-culosis infection .Results Sensitivities of acid-fast staining ,TB-DNA and serum anti-PPD-IgG in the TB group were 32 .01% , 51 .44% and 48 .56% respectively .The detectable rate of combining TB-DNA with serum PPD-IgG was 67 .63% .The detectable rate of combining TB-DNA with acid-fast staining was 54 .68% .The detectable rate of combining serum anti-PPD-IgG with acid-fast combined rate was 57 .55% .The detectable rate of combining three assays improved to 68 .71% .Conclusion Serum anti-PPD-IgG detection in the diagnosis of tuberculosis is simple ,effective ,qualitative detection of acid-fast staining sensitivity better than TB-DNA ,but it had a poor specificity .Bacteriologic diagnosis are tuberculosis diagnostic "gold standard",but the detectable rate for acid-fast bacilli is low .The qualitative of TB-DNA test had a better sensitivity and specificity than other two assay .Combining with three assays could increase detectable rate and improve diagnosis of tuberculosis disease .