结核抗体等5项检测指标不同联合对复治肺结核诊断价值的研究

目的　探讨结核抗体、C反应蛋白(CRP)、血红细胞沉降率(ESR)、结核菌素纯蛋白衍化物(PPD)皮肤试验、分枝杆菌聚合酶链反应(PCR)检测不同联合对复治肺结核诊断的临床价值。方法 结核抗体采用金标法,PCR检查采用荧光双标记定量法,ESR采用魏氏法,CRP采用免疫浊度法,结核菌素纯蛋白衍化物(PPD)皮肤试验按照国家规定。结果 5项检查的单项敏感性依次为PCR(92.0%)、结核抗体检测(81.3%)、ESR(80.0%)、PPD(68.3%)、CRP(66.7%);特异性依次为94.0%、87.0%、32.0%、72.0%、75.0%。任意联合其中2项检测指标的结果对复治肺结核诊断的敏感性明显上升;结核抗体与PCR联合检测的诊断特异性与其他联合相比更有价值(P<0.05)。联合3项及3项以上的检测指标敏感性达到或接近100.0%,但其特异性与PCR和结核抗体联合检测相比反而下降明显(P<0.01)。结论 在结核抗体、ESR、CRP、PPD、PCR等5项检测指标中,联合检测结核抗体与PCR对复治肺结核的诊断最有价值,在此基础上增加检测项目并不能提高对复治肺结核的诊断价值。

Study on the diagnostic value of tuberculosis antibody and the like five detection methods for retreated pulmonary TB

Objective To evaluate the diagnostic value of tuberculosis antibody, CRP, ESR, PPD skin test, PCR and combined the five method in the diagnosis of retreated pulmonary tuberculosis. Methods Tuberculosis antibody were measured by DIGFA (dot immunogold filtration assay), PCR by hybridization method, ESR by Westergram method, CRP by lmmunoturbidimetry Assay, and PPD skin test according to the national guideline. The sensitivity and specificity of single method and the diagnostic value of single and combined method were evaluated. Results The sensitivities of tuberculosis antibody, CRP, ESR, PPD skin test, and PCR were 92.0%,81.3%, 80.05,68.3%,66.7%, respectively;their specificities were 94.0%,87.0%,32.0%,72.0%,75.0%, respectively. In random combined 2 Methods the sensitivity increased markedly, the specificity of tuberculosis antibody combined with PCR was higher than that of other combinations(P<0.05).The sensitivities in combinations of 3 and more than 3 Methods reached approximately 100%,but their specificities decreased significantly. Conclusion The combination of tuberculosis antibody and PCR was more valuable among 5 methods. The other combination of more Methods couldn’t increase the diagnostic value for retreated pulmonary TB.