不同检测方法快速诊断结核性胸膜炎临床评价

摘要

Objective To investigate the roles of different methods for the rapid diagnosis of tuberculous pleurisy, and to find a method for rapid diagnosis. Methods A total of 50 patients with undiagnosed exudative pleural effusion were enrolled. Using thoracoscopy, the biopsy specimens of parietal pleura were taken under direct vision. Pleural effusion and biopsy specimens were subjected to bacterial culturing, polymerase chain reaction (PCR), histopathological microscopic examination (directly and after cytocentrifugation). Mononuclear cells were isolated from pleural effusion and determined by T cell spot test. Results The biopsy specimens proved to have a higher determination rate of Mycobacterium tuberculosis than pleural effusion. Cytocentrifugation improved the sensitivity of microscopic examination for pleural effusion increasing by 20.0％ and biopsy specimens increasing by37.5％. T cell spot test had higher sensitivity (98.6％) and speci?city (95.6％). Conclusions The combination of microbiological examination and histopathological examination of biopsy specimens is the best method for the diagnosis of tuberculous pleurisy, and microbiological examination using biopsy specimens has a higher determination rate than using pleural effusion. T cell spot test is worth the clinical application for the diagnosis of tuberculous pleurisy.%目的 探讨几种检测方法对结核性胸膜炎的诊断价值,以寻找更好的结核性胸膜炎快速诊断方法.方法 选取50例渗出性胸腔积液未确诊患者,进行经胸腔镜壁层胸膜活检.对胸腔积液和胸膜活检样本进行细菌培养、聚合酶链反应(PCR)、病理组织学等显微镜检查(直接和细胞离心后).对分离自胸腔积液的单核细胞进行T细胞斑点试验.结果 胸膜活检样本结核分枝杆菌阳性率高于胸腔积液样本.胸腔积液和胸膜活检样本经细胞离心处理后,敏感性分别提高到20.0％和37.5％.T细胞斑点试验敏感性(98.6％)和特异性(95.6％)较好.结论 胸膜活检样本的微生物学检查与病理组织学检查相结合是诊断结核性胸膜炎的最佳方法;胸膜活检样本的微生物学检查比胸腔积液样本有更高的阳性率;T细胞斑点试验作为辅助诊断结核性胸膜炎的方法值得在临床推广.