抗酸杆菌荧光染色镜检的应用研究

目的对荧光显微镜检测抗酸杆菌的应用进行评价。方法5个结核病专业诊疗机构共收集2157份标本，每份标本均采用荧光染色（FS）、萋-尼染色（Z-N染色）镜检。其中1245份标本同时进行传统培养检查，并且以培养结果为最终的金标准，计算FS和Z-N染色镜检方法的敏感度、特异度和正确指数正确指数-（敏感度＋特异度）-11（假阴性率＋假阳性率）]。所有结果采用SPSS17．0统计软件完成配对7。检验，以P〈O．05为差异有统计学意义。结果全部标本荧光染色镜检阳性率为10．8％（234／2157），萋-尼染色镜检阳性率为8．8％（190／2157），两种镜检方法阳性率差异有统计学意义（X2=25．473，P〈0．001）。初诊标本经荧光染色镜检的阳性率为15．9％（179／1127），萋一尼染色阳性率为13．2％（149／1127），荧光染色镜检检出抗酸杆菌的能力较萋尼染色高20．1％；两种镜检方法检查初诊标本的阳性率，差异有统计学意义（X2=18．000，P〈0．001）。同时完成涂片和培养的标本，荧光染色镜检阳性率13．8％（172／1245），培养阳性率15．2％（189／1245），两者比较差异无统计学意义（X2=2．173，P=0．140）。同时完成涂片和培养的初诊标本，荧光染色镜检阳性率16．4％（128／781），培养阳性率19．7％（154／781），分离培养阳性率较荧光染色阳性率高20．3％，差异有统计学意义（X2=7．861，P〈0．01）。荧光染色镜检的敏感度为60．3％（114／189）、特异度为94．5％（998／1056），假阴性率为39．7％（75／189）、结果正确指数为0．548，萋-尼染色镜检相应指标分别是56．6％（107／189），97．1％（1025／1056），43．4％（82／189）和0．537。结论与萋一尼染色镜检比较，荧光染色镜检具有更高的敏感度和很好的特异度；能够提高工作效率，降低工作强度，适合在工作量较大、人力资源紧张的基层实验室开展。

Evaluation of the application of fluorescent microscopy on detection of acid-fast bacillus

Objective To evaluate the application of fluorescent microscopy for detection of acid fast bacilli （AFB）. Methods 2157 clinical samples were collected from 5 clinics for pulmonary tuberculosis （PTB）, and all samples were detected by fluorescent staining （FS） microscopy and Ziehl-Neelsen （Z-N） microscopy, 1245 samples were conducted sputum culture as golden standard. The sensitivity, specificity and Youden＇s index （Youden＇s index： （sensitivity＋ specificity）- 1：1--（false negative rate＋ false positive rate）） of FS and Z-N were evaluated. All re- suits were compaired by Chi-square test with SPSS 17.0 statistical software, and P〈0.05 was set as the criteria of statistical significance. Results The positive rate of FS was 10.8% （234/2157）, and that of ZN was 8.8%（190/2157）, the difference was statistically significant between the two methods （Z2= 25. 473, P〈0. 001）. The positive rate detected by FS was 15.9%（179/1127） in the specimens of new cases, and that of Z-N was 13.2% （149/1127）, the difference was also statistically significant X2=18. 000, P%0. 001）. Among the specimens tested by smear and culture, the positive rate of FS was 13.8% （172/1245） and the positive rate of I.-J culture was 15.2%（189/1245）, and and there was no significant difference Ore =2. 173, P=0. 140）. Among the specimens of new ca- ses tested by smear and culture, the positive rate of FS was 16.4% （128/781） and the positive rate of L-J culture was 19.7% （154/781）, which was 20.3% higher than the FS, and the difference was statistically significant （）（2= 7. 861, P〈0.01）. The sensitivity of FS was 60.3% （114/189）, the specificity was 94.5% （998/1056）, the false negative rate was 39.70% （75/189） and Youden＇s index was 0. 548; corresponding results of Z-N were 56.6% （107/189）, 97. 1% （1025/1056）, 43.4%0 （82/189） and 0.537, respectively. Concision Compared with ZN,FS microscopy has higher sensitivity and similar specificity. Meanwhile, FS microscopy improves work efficiency, reduces labor intensity, which is suitable for basic laboratories with heavy workload and human resources shortage.