聚合酶链反应对活动性肺结核病的诊断价值探讨

目的：探讨聚合酶链反应(PCR)对结校病的临床诊断价值。方法：本对126例活动性肺结校病人的痰标本进行了检测。结果：发现PCR检出率为60.3％，高于痰培养的49.2％和痰涂片的38.1％。但涂阳病人中有22．9％PCR明性，82例非结核疾患有28.1％PCR阳性。结论；提示PCR阳性结果并非活动性结核病所特有。     

结核杆菌（TB）PCR荧光诊断试剂盒的临床应用

目的：探讨半定量ＴＢ－ＰＣＲ荧光探针诊断试剂盒的临床应用价值。方法 以双盲法对１１５例结核病和５９例非结核病人的痰标本进行厚涂片抗酸染色检查、结核菌培养、荧光探针ＴＢ－ＰＣＲ检查对比。结果：三种方法检测的敏感性分别为３２．２％，５９．１％，７１．３％，荧光探针ＴＢ－ＰＣＲ法的敏感性显著高于培养法和涂片法（Ｐ〈０．０１和Ｐ〈０．０５）。特异性分别为９３．２％、９１．５％、９４．９％，差异无显著性。结     

用RT－PCR测血清中柯萨奇B组病毒基因初探

本文用ＲＴ－ＰＣＲ对１００例临床不同病人血清中柯萨奇Ｂ组病毒基因作了检测，其阳性结果分别为：心血管疾病患者１９．６％（１０／５１），内科原因不明发热忍者７．１％（２／２８），儿科患者４．７％（１／２１），总阳性率为１３％（１３／１００）。并将阳性结果与心电图检查进行比较分析，以探讨ＰＣＲ技术对心肌炎疾病的诊断应用。     

PCR技术在儿科结核病诊断中存在的问题

观察多聚酶链反应技术在结核病临床诊断上的应用以及存在的问题，方法：２２例结核病符合临床诊断标准，５０例对照组，应用ＰＣＲ技术，经凝胶电泳法检测结果。结果血样本ＴＢ－ＤＮＡ－ＰＣＲ的阳性率为结核组１８．１８％，对照组３６．００％，敏感度１８．１８％，特异性６４．００％，假阳性３６．００％，假阴性８１．８２％。     

PCR方法诊断重症急性胰腺炎继发全身性感染13例研究

目的 探讨以１６ｓｒＲＮＡ和１８ｓｒＲＮＡ基因为基础的细菌和真菌ＰＣＲ方法诊断重症急性胰腺炎继发全身性感染的价值。方法 对急性胰腺炎的血标本进行细菌、真菌通用引物ＰＣＲ检测,并同常规培养比较。结果 对于所收集１３例重症急性胰腺炎患的２２份血标本,细菌培养阳性１例,真菌培养阳性１例,阳性检出率分别为４．５％和４．５％;而细菌ＰＣＲ检测阳性有７例,真菌ＰＣＲ阳性为１份,阳性检出率分别为３１．８％和４     

活动性结核标志物与PCR对照检测诊断肺结核的临床应用探讨

目的：探讨活动性结核标志物（ＡＴＭ）和ＰＣＲ对肺结核的临床应用价值。方法：对１６３例患者分别进行痰、血ＰＣＲ检测和痰涂片结核菌检查的同时用同一患者血清行ＡＴＭ检测,观察其阳性率。结果：４２例肺结核、５４例疑诊肺结核、２７例结核性胸液患者经痰、血ＰＣＲ和血清ＡＴＭ检测,两种检测方法阳性率差异光显著意义（Ｐ〉０．０５）,痰ＰＣＲ检测阳性率高于血ＰＣＲ检测。两 民普涂片结核菌检查差异具有非常显著意义（Ｐ     

PCR检测技术在结核病诊断中的价值

用ＰＣＲ技术对１７５例临床可疑结核病，但常规培养或抗酸染色阴性的病理标本中结核菌ＤＮＡ进行了检测。结果发现有２２．３％（３９／１７５）的样本结核菌ＤＮＡ阳性。结果提示，ＰＣＲ技术在检测结核菌ＤＮＡ中具有简便、快速和灵敏的特点，其阳性结果说明被测样品中有结核菌的存在，对结核病的确诊有重要辅助意义。     

412例农民肺结核情况调查分析

从第三次全国结核病流行病学调查结果估算，全国现有活动性肺结核病人593万，痰涂片阳性肺结核病人151．4万，每年死于结核病者为23.8万。从本省1990年流行病学调查结果估算，本省现有活动性肺结核病人30万，痰涂片阳性病人10万，每年死于结核病者约1万人。这说明结核病在我国、本省仍然是一种常见病、多发病，严重威胁着人们的身体健康。现将本院1993年住院的肺结核病人978例（尤其是其中412例农民）情况作一分析。1临床资料1．1一股资料自1993年1月1日至1993年12月31日，本院共收治病人1773例，其中结核病人978例（55．2％）。结核病人中…     

聚合酶链反应在肺结核诊断中的应用价值

１９９７年３月－１９９７年１２月，１７６例患者，肺结核者３６例，结核性胸膜炎者４２例，非结核性痰标本９８例，同时行ＰＣＲ法和涂片镜检法（痰／胸水）比较。结果表明ＰＣＲ有很高检出率（７７．８％和７６．１９％）。该项技术为结核病早期诊断开辟了新的前景。     

聚合酶链反应检测痰标本中结核菌的临床应用--附284例检测结果

目的：探讨ＰＣＲ检测痰标本中结核菌诊断肺结核的价值。方法：收集１９９３年４月至１９９６年６月我科用ＰＣＲ检测２８４例肺部疾病患者痰标一中结核菌的资料与涂片及结核菌培养比较，结果：肺结核病组ＰＣＲ检测结核菌阳性率明显高于涂片（６３．８％比２４．３％）及培养法（６８．９％比３３．８％）。结论：ＰＣＲ检测痰标本中结核菌培养法灵敏性，特异性高。     

2004-2007年太原市肺结核病发现状况与转归分析

目的 分析山西省太原市结核病发现与治疗转归情况。方法　根据太原市2004-2007年结核病季报表进行病例发现及治疗转归队列分析。结果　4年全市共新登记涂阳肺结核病例4411 例。涂阳肺结核病例占活动性肺结核病例的比例从2004年的38.2%提高到2007年的57.3%。涂阳新登记率从2004年的19.1/10万上升到2007年的38.0/10万。平均治愈率为91.6%。结论　2004-2007年太原市结核病患者的发现与治疗管理水平不断提高,取得了显著成效,是实施现代结核病控制策略的结果。     

Detection of Mycobacterium tuberculosis DNA in respiratory and nonrespiratory specimens by the Amplicor MTB PCR

To evaluate the diagnostic performance of a commercially available Mycobacterium tuberculosis PCR assay (Amplicor MTB-ROCHE), 2296 respiratory and nonrespiratory specimens from 2296 patients with suspected tuberculosis (TB) were collected prospectively in an 8-year period. Clinical data for each patient were abstracted, and all samples were examined blindly by direct microscopy, culture, and PCR. M. tuberculosis DNA was detected in 93 of 113 culture-positive samples and in 29 of 38 samples from patients with probable TB. The lowest sensitivity was observed in pleural fluid and abscess aspirates. The sensitivity, specificity, and positive predictive value of the assay were 97.2%, 100%, and 100% for smear-positive specimens and 75.3%, 97.0%, and 47.5% for smear-negative specimens, respectively. The PCR cost per additional correct clinical decision was Euro 2826 but would have declined to Euro 308 if the test was applied only to smear-positive specimens. The overall performance of Amplicor MTB test was excellent for smear-positive, but suboptimal for smear-negative specimens.     

2008-2013年浙江省诸暨市涂阳肺结核学生患者的密切接触者结核感染情况调查

目的调查分析涂阳肺结核学生患者的密切接触者感染情况及影响因素,为进一步防止结核病在学生中的扩散和蔓延提供依据。方法通过在诸暨市2008-2013年发生的涂阳肺结核学生患者的密切接触者的结核菌纯蛋白衍生物(purified protein derivative of tuberculin,PPD)筛查,以非密切接触者为感染情况作为本底对照;分层分析密切接触者感染情况的影响因素。结果调查28例涂阳肺结核学生患者密切接触者共1721人,强阳性400人,强阳性率为23.24%。同时调查非密切接触者1409人,强阳性39人,强阳性率为2.77%,密切接触者的强阳性率远高于非密切接触者(χ2=269.33,P=0.000)。影响密切接触者PPD试验结果的因素有发病季节、痰菌含量及就诊延误,通过分层分析,冬春季发病患者的密切接触者阳性率较高,特别是患者痰菌含量较高时(χ2=10.12,P=0.00;χ2=5.35,P=0.02);痰菌含量高的患者其密切接触者阳性率高,在春季发病患者的密切接触者中尤其明显(χ2=14.42,P=0.00;χ2=11.25,P=0.00);传染源诊断延误时间对密切接触者强阳性率的影响表现为患者痰菌含量较低时,冬春季发病患者的不同诊断延误患者的密切接触者强阳性率不同(χ2=4.60,P=0.03);而患者痰菌含量较高时,不同季节发病患者的密切接触者强阳性率差异无统计学意义。结论在影响涂阳肺结核学生患者PPD试验强阳性率的主要因素中,传染源的发病季节、痰菌含量和诊断延误各自起着一定的作用,其中以发病季节和痰菌含量的作用更为显著。     

Treatment of latent tuberculosis infection in contacts of new tuberculosis cases in the United States

BACKGROUND: Few data are available describing treatment completion rates among recently infected contacts of tuberculosis (TB) cases, a group at high risk for development of active TB. METHODS: Health department records were reviewed for all contacts of 360 culture-positive pulmonary TB cases reported from five health departments in the United States in 1996. RESULTS: Of 2,267 contacts who completed screening, 630 (28%) had newly documented positive skin tests (121 with skin test conversion). Treatment of latent TB infection was documented to have been recommended for 447 (71%). Among these, treatment was documented to be initiated for 398 (89%). Of these, 203 (51%) were documented to have completed a 6-month course of treatment, and 78 (20%) received directly observed treatment. Treatment was recommended more often for contacts < 15 years of age, skin test converters, close contacts, and contacts of smear-positive cases. Treatment completion rates were higher for skin test converters. CONCLUSIONS: In this study, fewer than one third of all persons with newly documented positive skin tests detected during contact investigations were proven to have completed treatment. Achieving high rates of completion of therapy for latent TB infection in recently infected contacts of active cases of pulmonary TB is essential to maximize public health prevention efforts aimed at eliminating TB.     

痰涂片阳性与阴性初治肺结核患者临床状况的比较

目的通过对痰涂片阳性（简称涂阳）与痰涂片阴性（简称涂阴）初治肺结核患者患病前后的情况进行比较分析,了解涂阳肺结核患者的高危因素、疾病特征和心理特点。方法对101例初治肺结核患者（涂阴55例、涂阳46例）患病前后的有关情况进行问卷调查,并采用描述性统计、X^2检验及秩和检验进行统计学分析。结果涂阳组与涂阴组患者在性别、患病前的健康状况、劳累程度、确诊时间、治疗时间、血浆白蛋白、抑郁发生率和血糖等方面均有统计学意义（P〈0．01或P〈0．05）。结论保持良好的健康状况、避免过度劳累、积极治疗和控制各种慢性病对预防肺结核的发生、减轻病情、降低传染性具有重要意义;肺结核的高危人群应定期体检;对肺结核患者应做好饮食指导及心理辅导,帮助患者树立战胜疾病的信心和良好的心态,以利于疾病的康复。     

湖南省186例新发涂阳肺结核病患者首诊医疗机构情况分析湖南省186例新发涂阳肺结核病患者首诊医疗机构情况分析

目的　分析新发涂阳肺结核病患者首次就诊医疗机构情况,探讨涂阳肺结核病患者首次就诊医疗机构对结核病发现工作的影响。方法　采用非概率抽样,选择湖南省郴州市桂阳、宜章、永新、北湖区共4县（区）为调查现场,利用调查表,前瞻性收集2007年4月中旬至10月中旬就诊的新发涂阳肺结核患者基本情况,首发症状,首诊医疗机构及就诊后的首次检查等信息。结果　共收集186例新发涂阳患者的资料。首次选择到非结核病防治机构就诊者占97.8 % （182/186）;首诊选择在药店、个体诊所的患者有22人（占35.5%）需3次才被确诊为结核;患者因离家近方便而选择相应医疗机构的比例为58.6%（109/186）;县级及以上综合医院的转诊率为67.1%（47/70）,村医务室、乡镇卫生院和乡中心卫生院的日常推荐率为26.5%（13/49）;首次就诊没进行任何检查的比例为50.5%（94/186）;县级及以上综合医院的痰检率为2.9%（2/68）;结核病相关知识不知晓率为47.3%（88/186）。 结论　首诊选择非结核病专业防治机构的患者比例较高; 村医务室、乡镇卫生院和乡中心卫生院的日常推荐率相对较低;综合医院痰检率非常低。因而,首先要有针对性地加大结核病相关知识的宣传力度,提高患者主动就诊结核病防治机构的比例,才能及时发现患者;其次,可考虑进一步完善结核病防治体系,如药店和个体诊所纳入到体系中;健全卫生行政部门主导下的业务培训体系等,来增加结核病的发现力度。     

结核感染T细胞斑点试验联合外周血血小板计数、血小板–淋巴细胞比值对活动性肺结核与非活动性肺结核的鉴别意义

目的 探讨结核感染T细胞斑点试验（T-SPOT.TB）及外周血血小板计数（PLT）、血小板-淋巴细胞比值（PLR）对活动性肺结核与非活动性肺结核的鉴别意义。方法 回顾性分析宜春市人民医院2019年1月至2021年6月临床病例250例（活动性肺结核患者115例,非活动性肺结核患者63例,非结核性肺炎72例）,收集其T-SPOT.TB试验结果、外周血白细胞计数、血小板计数、PLR、细菌抗酸染色等实验室结果和最终诊断,并做统计学分析。结果 非结核肺炎患者T-SPOT.TB阳性率为4.17%,明显低于非活动肺结核患者T-SPOT.TB阳性率（82.54%）和活动性肺结核患者T-SPOT.TB阳性率（85.22%）;活动性肺结核组的血小板计数、PLR均高于非活动性肺结核组及非结核肺炎组。T-SPOT.TB、PLT、PLR多因素logistic回归分析表明,T-SPOT.TB联合PLT、PLR诊断活动性肺结核灵敏度为63.30%,特异度为86.50%。结论 T-SPOT.TB联合PLT、PLR有助于鉴别诊断活动性肺结核与非活动性肺结核,为临床提供是否抗结核治疗的依据。     

Clinical evaluation of QuantiFERON TB-2G test in patients with healed pulmonary tuberculosis

We evaluated the response to the QuantiFERON TB-2G (QFT-2G) test in patients with healed pulmonary tuberculosis (TB) compared to the response in those with active pulmonary TB. The subjects were 208 patients with healed pulmonary TB and 155 patients with active pulmonary TB. The QFT-2G test results were analyzed by stratifying them into 5- or 10-year periods after the completion of antituberculosis treatment. Of the 208 patients with healed pulmonary TB, 63% had a positive tuberculin skin test (TST) and 34% had a positive QFT-2G test result. There was no significant difference in the positive response rate for the QFT-2G test, or in the positive test result rate for only the early secretory antigenin target 6-kD protein (ESAT-6) antigen, only the culture filtrate protein 10 (CFP-10) antigen, or both the ESAT-6 and CFP-10 antigens among any subgroups stratified by 5- or 10-year periods after the completion of antituberculosis treatment. The positive rate for the QFT-2G test was significantly higher in patients with active pulmonary TB (83%) than in patients with healed pulmonary TB (34%). Regarding the combined and separate responses to both the ESAT-6 and CFP-10 antigens, the positive response rate for both antigens was significantly lower in patients with healed pulmonary TB than in those with active pulmonary TB. Because many patients continued to show a positive response to the QFT-2G test even when a long period had passed after the completion of the antituberculosis treatment, it is suggested that, in patients with a previous history of TB, particular attention must be paid to the relapse of TB or reinfection with TB.     

实时荧光定量PCR检测血浆结核分枝杆菌DNA的初步临床应用

目的 评价实时荧光定量PCR技术检测血浆（或血清）结核分枝杆菌（Mycobacterium tuberculosis,MTB）DNA的技术。方法 建立实时荧光定期量PCR方法测定血浆MTB DNA,分别检测临床确诊的55例结核病患者血清43份,血浆25份以及非结核肺部疾病患者血清18份,健康体检血清18份和健康体检者血浆11份的MTB DNA含量。结果 18例非结板肺疾病患者血清、18例健康体检者血清以及11例健康体检者血浆MTB DNA全部阴性。55例初诊结核患者中10例（18．2％）治疗前血浆（或血清）MTB DNA阳性。在痰涂片阴性的18例结核患者中,血浆（或血清）MTB DNA阳性检出率为27．8％（5／18）,其特异性达100％。结论 本研究证实了结核患者血浆（或血清）循环MTB DNA的存在,其定量检测对痰涂片阴性及无痰患者的结核病诊断有重要参考价值。     

Molecular detection of Mycobacterium tuberculosis: impact on patient care

BACKGROUND: Nucleic acid amplification technologies such as PCR are revolutionizing the detection of infectious pathogens such as tuberculosis (TB). Amplification technology offers the potential for the diagnosis of TB in a few hours with a high degree of sensitivity and specificity. However, molecular assays neither replace nor reduce the need for conventional smear and culture, speciation, and antibiotic sensitivity assays. METHODS: We undertook prospective studies of sputum samples to assess the performance of two PCR-based assays for the detection of TB as well as the impact of more rapid availability of test results on patient care. RESULTS: The sensitivity of both the in-house and Amplicor PCR assays was 100% for smear-positive sputa. For smear-negative sputa (two sputum samples collected during the first 24 h of hospitalization), the sensitivity was 85% for our in-house PCR assay and 74% for the Roche PCR assay. Approximately 10% of the smear- and culture-negative sputa yielded positive PCR results; however, more than one-half of these were positive with both the in-house and Amplicor assays, suggesting the presence of TB DNA or organisms. Several of these came from patients whose other samples grew Mycobacterium tuberculosis during the same admission, and others came from patients who had previously treated TB. Overall, the specificities of the in-house and Amplicor PCR assays in smear-negative patients were 86% and 93%, respectively. CONCLUSIONS: Molecular detection of slow-growing pathogens such as M. tuberculosis have the potential to improve clinical care through a dramatic reduction in the time required for detection and may provide substantial savings in the overall cost of care of a patient compared with conventional smear, culture, and speciation alone, despite the fact that conventional assays must still be performed for speciation of nontuberculous mycobacteria and for full assessment of antibiotic sensitivity.