4种方法联合检测在菌阴肺结核临床诊断价值的研究

目的　探讨痰聚合酶链反应——微孔板杂交技术(PCR ELISA)、抗脂阿拉伯甘露糖(LAM-IgG)抗体、结核菌素(PPD)1TU皮试以及血清可溶性白细胞介素2受体(sIL-2R)水平,4种方法联合检测对初治菌阴肺结核患者临床诊断的意义。方法 以上述4种方法检测初治菌阳肺结核57例,初治菌阴肺结核58例,非结核肺疾病41例,健康对照36例。分别进行单项与联合检测,观察初治菌阴肺结核的特异性与敏感性。结果 PCR-ELISA、LAM-IgG、TB-PPD及sIL-2R单项检测对菌阴肺结核的阳性检出率依次分别为 43.1%,37.9%,31.0%,50.0%。联合检测对菌阴肺结核的阳性检出率2联、3联及4联依次分别为 56.9%,70.7%,84.5%,与单项检测的最高阳性检出率相比由50.0%提高到84.5%;联合检测的特异性分别为92.2%,88.3%和84.4%。结论 通过4种方法联合检测能显著提高菌阴肺结核的阳性检出率,同时也保持了相对高的特异性。联合检测对于菌阴肺结核的诊断,具有实用意义。

Study on 4 kinds of methods combination for detection of primary smear and culture negative pulmonary tuberculosis

Objective To evaluate the diagnostic value of 4 ki nds of methods combination used for primary smear and culture negative pulmonary tuberculosis.Methods The 4 testing methods were PCR ELISA exa mination for sputum;TB DNA, MycoDot method for serum LAM IgG,sandwich ELISA me thod for serum;sIL 2R and PPD 1TU skin test.4 testing methods were used individ ually and in combination manner respectively to 57 smear and culture positive cases,58 smear and culture negative cases,41 non tuberculosis respiratory patien ts and 36 healthy people in control group.Results The positive detection rate of single test by PCR ELIS A,LAM IgG,PPD and sIL 2R for sputum TB negative patients was 43.1% ,37.9%,31.0%,50.0% respectively. In combination examination the positive rate s increased remarkblely by the number combined from 2 to 4, they were 56.9%,70. 7%,84.5% respectively,and the specificity was 92.2% ,88.3%,88.4% ,remain a hi gher speci ficity.Conclusion Using the 4 kinds of methods to diagnose prim ary smear and culture negative pulmonary tuberculosis patients can increase the positive rates of detection obviously and remain a higher specificity. It is val uable for widely use of combination method in detection of primary smear and cul ture negative tuberculosis patients.