液基细胞学技术在肺结核诊断中的应用价值

目的 探讨液基细胞学技术(thinprep cytologic test,TCT)在肺结核诊断中的应用价值。方法 按照患者纳入标准搜集2017年11月至2019年2月河北省张家口市传染病医院诊治的248例初诊为疑似肺结核的患者,最终临床综合诊断确诊为肺结核患者181例,非肺结核患者67例。由结核科医生根据相应临床表现及体征按照每例患者选用1种类型临床标本的原则共采集248份临床标本,包括101份晨痰标本、67份胸腔积液标本、80份支气管肺泡灌洗液标本。248份标本均行TCT、萋-尼抗酸染色涂片镜检(Ziehl-Neelsen 染色涂片法镜检,简称“Z-N涂片法”)、BACTEC^TM MGIT 960液体培养法(简称“MGIT 960法”)检测分枝杆菌。采用SPSS 19.0软件进行数据的统计学分析,计数资料间的比较采用χ²检验,以P<0.05为差异有统计学意义。 结果 TCT检测248份标本、痰液标本、胸腔积液标本、支气管肺泡灌洗液标本的阳性率分别为53.63%(133/248)、67.33%(68/101)、17.91%(12/67)、66.25%(53/80)]均明显高于Z-N涂片法 分别为25.81%(64/248)、36.63%(37/101)、7.46%(5/67)、27.50%(22/80)](χ²值分别为46.788、19.736、9.449、20.833,P值分别为0.000、0.000、0.002、0.000);但TCT检测痰标本的阳性率明显低于MGIT 960法81.19%(82/101)](χ ²=5.076,P=0.024),而检测胸腔积液及支气管灌洗液标本的阳性率与MGIT 960法分别为25.37%(17/67)、70.00%(56/80)]差异均无统计学意义(χ ²=1.100,P=0.294;χ ²=0.377,P=0.539)。以临床诊断为参考标准,TCT、Z-N染色法、MGIT 960法检测所有临床标本的敏感度分别为72.93%(132/181)、30.39%(55/181)、85.64%(155/181),一致率分别为79.84%(198/248)、48.79%(121/248)、89.52%(222/248),特异度分别为98.51%(66/67)、98.51%(66/67)、100.00%(67/67)。 结论 TCT检测痰液、胸腔积液及支气管肺泡灌洗液标本中分枝杆菌的阳性率、敏感度均高于Z-N涂片法,对诊断肺结核具有重要临床应用价值。

Application value of thinprep cytologic test in the diagnosis of pulmonary tuberculosis

Objective To explore application value of Thinprep cytologic test (TCT) in the diagnosis of pulmonary tuberculosis.Methods According to inclusion criteria,248 suspected tuberculosis patients from Zhangjiakou Infectious Disease Hospital between November 2017 and February 2019 were selected, and based on confirmed diagnosis,181 were pulmonary tuberculosis, while the other 67 were not. A total of 248 samples including sputum (n=101), pleural effusion (n=67) and bronchoalveolar lavage fluid (n=80), from the 248 patients one each according to their clinical features and symptoms, were tested with TCT, Z-N staining and MGIT 960, to detect mycobacterium. Data were analyzed by χ ² test using SPSS 19.0, P<0.05 was considered statistically significant. Results The positive rates of all 248 samples (53.63% (133/248) vs. 25.81% (64/248), χ ²=46.788, P=0.000), sputum (67.33% (68/101) vs. 36.63% (37/101), χ ²=19.736, P=0.000), pleural effusion (17.91% (12/67) vs. 7.46% (5/67), χ ²=9.449, P=0.002) and bronchoalveolar lavage fluid (66.25% (53/80) vs. 27.50% (22/80), χ ²=20.833, P=0.000) using TCT were significantly higher than those using Z-N staining. The positive rate of sputum using TCT was significantly lower than using MGIT 960 (67.32% (68/101) vs. 81.19% (82/101), χ ²=5.076, P=0.024), while the difference of the positive rates of pleural effusion (17.91% (12/67) vs. 25.37% (17/67), χ ²=1.100, P=0.294) and bronchoalveolar lavage fluid (66.25% (53/80) vs. 70.00% (56/8), χ ²=0.377, P=0.539) between the two methods were not statistically significant. Based on clinical diagnosis, sensitivities of TCT, Z-N staining and MGIT 960 in testing all the samples were 72.93% (132/181), 30.39% (55/181) and 85.64% (155/181), respectively; the consistency rates of the three methods were 79.84% (198/248), 48.79% (121/248) and 89.52% (222/248), respectively; the specificities were 98.51% (66/67), 98.51% (66/67) and 100.00% (67/67), respectively. Conclusion The positive rate and sensitivity of TCT in detecting mycobacterium from sputum, pleural effusion and bronchoalveolar lavage fluid were higher than those of Z-N staining, which is of important application value in clinical diagnosis.