RNA恒温扩增实时检测技术与荧光定量PCR联合检测肺泡灌洗液对痰涂阴性肺结核的快速诊断价值

发布时间：2018-03-01 06:34

本文关键词： 核酸扩增技术结核分枝杆菌 ROC曲线支气管肺泡灌洗液联合试验　出处：《中华医院感染学杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的通过采用RNA恒温扩增实时检测技术(FQ-PCR)两种不同类型靶标核酸检测方法联合检测支气管肺泡灌洗液(BALF)标本,评估联合应用对痰涂阴性肺结核的诊断价值。方法采集2014年11月-2016年5月医院收治的疑诊为肺结核并且痰涂片至少3次阴性的1 155例患者灌洗液标本,剔除295例未明确诊断病例,肺结核确诊患者672例纳入肺结核组,其他肺部疾病188例(包括43例非结核分枝杆菌疾病)纳入对照组,以临床诊断为金标准,计算SAT-TB与FQ-PCR联合检测的各类评价指标,并与单一SAT-TB、FQ-PCR、结核分枝杆菌快速培养(Bactec MGIT 960)、抗酸杆菌染色进行比较,绘制受试者工作特征曲线(ROC)进行分析比较。结果以临床诊断为"金标准",分别以AFS、MIGT960、SAT-TB、FQ-PCR、SAT-TB与FQ-PCR联合检测平行试验(单阳)、系列试验(双阳)为检验变量时,ROC曲线下面积(AUC)依次为0.507、0.501、0.670、0.660、0.734、0.658,准确性依次为29.45%、33.64%、58.67%、58.32%、67.40%、49.82%,SAT-TB和FQ-PCR单独检测或者联合检测其诊断价值均有统计学意义(P0.001);对痰涂阴性肺结核病诊断价值比较,平行试验SAT-TBFQ-PCR系列试验涂片MIGT960。结论与细菌学检测方法比较,SAT-TB与FQ-PCR联合检测痰涂阴性肺结核病诊断具有快速、敏感、鉴别结核分枝杆菌(MTB)与非结核分枝杆菌(NTM)等优势,缩短了确诊时间,提高准确率,给痰涂阴性肺结核患者提供一种有效辅助手段,值得临床推广应用。
[Abstract]:Objective to detect bronchoalveolar lavage fluid (BALF) specimens by two different types of target nucleic acid detection methods using RNA constant temperature amplification real-time detection technique (FQ-PCR). To evaluate the diagnostic value of combined use in sputum smear negative pulmonary tuberculosis. Methods from November 2014 to May 2016, 1 155 cases of suspected pulmonary tuberculosis with negative sputum smear at least 3 times were collected. Among 295 cases without definite diagnosis, 672 cases of pulmonary tuberculosis were included in the pulmonary tuberculosis group, 188 cases of other pulmonary diseases (including 43 cases of non-tuberculosis mycobacterium disease) were included in the control group, and the clinical diagnosis was taken as the golden standard. The evaluation indexes of SAT-TB and FQ-PCR were calculated and compared with those of SAT-TBX FQ-PCR, mycobacterium tuberculosis, Bactec MGIT 960C, and acid-fast bacillus staining. Results according to clinical diagnosis as the "gold standard", the area under the ROC curve was measured with AFSS-MI960GT-TBX FQ-PCRT-TB and FQ-PCR respectively (single test, series test (Shuangyang) as the test variable) and the area under the ROC curve, respectively, when the ROC curve was taken as the "gold standard" for the clinical diagnosis, and the area under the ROC curve was measured in the parallel test (single test, series of tests (Shuangyang)). The results showed that the accuracy of SAT-TB and FQ-PCR in turn was 29.455.33.646.64 and 58.32mg / 58.32, respectively, and the diagnostic value of SAT-TB and FQ-PCR were significantly higher than that of negative sputum smear pulmonary tuberculosis (P 0.001), and the diagnostic values of SAT-TB and FQ-PCR were 0.5070.501and 0.7340.58 respectively, and the diagnostic values of SAT-TB and FQ-PCR were all statistically significant (P 0.001), and the diagnostic values of SAT-TB and FQ-PCR were significantly higher than those of negative sputum smear smears (P < 0.05). Parallel test SAT-TBFQ-PCR series smear MIGT960.Conclusion compared with bacteriological detection method, SAT-TB combined with FQ-PCR is rapid and sensitive in the diagnosis of sputum smear negative pulmonary tuberculosis. It can shorten the time of diagnosis, improve the accuracy, and provide an effective assistant method for sputum smear negative pulmonary tuberculosis patients, which is worth popularizing and applying in clinic.
【作者单位】：杭州市红十字会医院结核病诊疗中心;
【基金】：杭州市卫计委资助项目(2015A22)
【分类号】：R521

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