病理组织中的病原学检查对结核病的诊断价值

目的:探讨病理组织中的病原学检查对结核病的诊断价值。方法:选择2016年5月至2019年5月深圳市第三人民医院收治的190例疑似或确诊为结核病患者的病理标本，将190份标本按照病理形态分为4组：组1为坏死性肉芽肿组(109份)，组2为非坏死性肉芽肿组(20份)，组3为普通炎症组(45份)，组4为非结核病变组(16份)。...

Diagnostic value of pathogenic detection in pathological tissue for tuberculosis

Objective To understand the diagnostic value of tuberculosis(TB)pathogenic detection methods(TPDM)in pathological tissue for TB.Methods A retrospective study was conducted with 190 pathological specimens from different tissues suspected with TB from Third People′s Hospital of Shenzhen during May 2016 and May 2019.Specimens were divided into four groups according to histomorphology:group one,necrotizing granulomatous inflammation(109 cases);group two,non-necrotic granulomatous inflammation(20 cases);group three,non-granulomatous inflammation(45 cases);group four,non-tuberculous lesions(16 cases).The positive rates of each TPDM among specimens from four groups were compared.The positive rates of all TPDM for specimens from group one were compared.Meanwhile,the influence of antituberculosis treatment course on the TPDM was analyzed.Chi-square test or Fisher′s exact test was used for statistical analysis.Results The positive rates of Ziehl-Neelsen acid-fast staining among the four groups were 17.4%(19/109),5.0%(1/20),4.4%(2/45)and 0(0/16),respectively.The positive rates of Mycobacterium tuberculosis(MTB)complex culture were 32.0%(32/100),4/19,4.8%(2/42)and 0(0/16),respectively.The positive rates of Mycobacterium tuberculosis/rifampin resistance real-time quantitative nucleic acid amplification detection system(Xpert MTB/RIF)were 74.3%(81/109),15.0%(3/20),13.3%(6/45)and 0(0/16),respectively.The positive rates of fluorescent quantitative polymerase chain reaction(FQ-PCR)were 63.0%(58/92),0(0/15),2.6%(1/38)and 0(0/10),respectively.The positive rates of simultaneous amplification and testing(SAT)were 32.4%(24/74),0(0/10),0(0/15)and 0(0/10),respectively.The differences of each TPDM among four groups were all statistically significant(all P<0.05).The positive rate of Xpert MTB/RIF in group one specimens was significantly higher than those of acid-fast staining,MTB culture and SAT(x²=71.016,37.162 and 35.679,respectively,all P<0.01),while the difference was not statistically significant when compared with FQ-PCR(x²=2.517,P=0.112).The positive rate of combined TPDM(85.3%(93/109))was significantly higher than Xpert MTB/RIF(74.3%(81/109))(x²=4.100,P=0.043).The positive rates of acid-fast staining group 1A(anti-tuberculosis treatment course was less than one month)and group 1B(anti-tuberculosis treatment course was longer than one month)were 14.3%(7/49)and 20.0%(12/60),respectively(x²=0.612,P=0.434);those of MTB culture were 48.9%(22/45)and 18.2%(10/55),respectively(x²=10.721,P=0.001);those of Xpert MTB/RIF were 69.4%(34/49)and 78.3%(47/60),respectively(x²=1.131,P=0.287);those of FQ-PCR were 55.0%(22/40)and 69.2%(36/52),respectively(x²=1.965,P=0.161);those of SAT were 43.3%(13/30)and 25.0%(11/44),respectively(x²=2.736,P=0.098).Conclusions The results of TPDM correlate closely with the typical histomorphological features of tuberculosis.Xpert MTB/RIF possesses significantly higher sensitivity than any other single TPDM,and is not attenuated by early anti-tuberculosis treatment.Combined TPDM could significantly improve the sensitivity of TB pathogenic detection,which is suggested to be applied when the tissue specimen is sufficient.