改良抗酸染色法在结核性浆膜炎临床诊断中的价值

目的 应用改良的抗酸染色法(改良法)对确诊的结核性浆膜炎患者进行回顾性诊断,并与传统的抗酸染色法(传统法)相比较,以评估改良法对结核性浆膜炎的临床诊断价值。 方法 48例确诊结核性浆膜炎患者的浆膜腔积液同时送检改良法和传统法。其中,胸腔积液33例,腹腔积液15例。全部患者浆膜腔积液均为首次采集,采集时未经抗结核治疗(未治疗)患者28例,已进行抗结核治疗(已治疗)患者20例。 结果 48例患者改良法和传统法抗酸杆菌检出率分别为58.33%(28/48)和6.25%(3/48),两者差异有统计学意义(P=0.000);28例未治疗患者改良法抗酸杆菌检出率为71.43%(20/28),显著高于传统法3.57%(1/28,P=0.000);已治疗患者改良法抗酸杆菌检出率为40%(8/20),明显低于未治疗患者(P<0.05)。改良法和传统法阳性标本细胞外均检出抗酸杆菌,改良法检出胞内菌,传统法则均未检出。 结论 改良法显著提高了抗酸杆菌的检出率。而胞内菌的检出,对于判定细菌的存在则更具特异性。改良法极大地提高了诊断率,对于结核性浆膜炎患者的早期诊断和治疗,具有很高的临床应用价值。

Clinical Diagnosis Value of the Modified Ziehl-Neelsen Stain in the Tuberculous Serositis Patients

Objective To compare modified Ziehl-Neelsen stain (MZN stain) with the conventional Ziehl-Neelsen stain of Mycobacterium tuberculosis(M. tuberculosis) for the detection rate in tuberculous serositis patients and evaluate the diagnostic value of the modified ZN stain. Methods Samples of 48 patients diagnosed with Tuberculous serositis were stained by the conventional and modified ZN stain. There were 33 tuberculous pleurisy patients and 15 tuberculous peritonitis ones. Twenty-eight patients did not receive anti-tuberculosis treatment while 20 patients were undergoing treatment at the time of the samples being collected. Results Our modified method yielded a 58.33%(28/48) detection rate of M. tuberculosis, while the detection rate of the conventional one was 6.25%(3/48)(P<0.001). The detection rate were higher with the modified ZN stain than that with conventional one in untreated patients, which were 71.43%(20/28)and 3.57%(1/28,P<0.001), respectively. The detection rate of modified method in patients who were undergoing treatment was 40%(8/20)(P<0.05),which was obviously lower than that of the untreated patients. The extracellular acid-fast bacilli (AFB) could be identified both by modified and conventional method, while the intracellular AFB can be only detected by the modified stain but not the conventional one. Conclusion Compared with the conventional ZN stain, the modified one significantly increased the detection rate of M. tuberculosis in tuberculous serositis patients, especially the intracellular AFB can be detected by the modified by not conventional ZN stain. Therefore, the modified method would be of tremendous value in improving the diagnosis of tuberculosis.