免疫组织化学及PCR技术在淋巴结结核病理诊断中的应用价值

目的 探讨免疫组织化学(immunohistochemistry,IHC)及PCR技术在淋巴结结核病理学诊断中的应用价值。方法 收集首都医科大学附属北京胸科医院病理科保存的2012年1月至2013年7月之间的48例手术根治切除淋巴结结核患者(结核组)和21例非淋巴结结核患者(非结核组)的石蜡包埋组织标本,分别应用IHC染色、荧光定量PCR和抗酸染色法对标本进行检测,以临床最后诊断为金标准,比较各方法的检测效能。结果 IHC染色、荧光定量PCR及抗酸染色检测的敏感度分别为52.1%(25/48)、60.4%(29/48)及27.1%(13/48);IHC染色和荧光定量PCR检测敏感度均高于抗酸染色,差异均有统计学意义(χ ²值分别为 6.27、10.84,P值分别为0.012、0.001);而IHC染色与荧光定量PCR比较,敏感度差异无统计学意义(χ ²=0.68,P=0.411)。IHC染色、荧光定量PCR及抗酸染色法检测非结核组结果均为阴性,特异度均为100%(21/21)。IHC染色、荧光定量PCR及抗酸染色法的阴性预测值分别为47.7%(21/44)、52.5%(21/40)、37.5%(21/56);符合率分别为66.7%(46/69)、72.5%(50/69)、49.3%(34/69),IHC染色、荧光定量PCR均优于抗酸染色法。 结论 IHC染色、荧光定量PCR与抗酸染色法相比,可提高阳性检出率,在淋巴结结核的病理学诊断中具有良好应用价值。

Clinical application of immunohistochemistry and PCR technique in pathological diagnosis of tuberculous lymphadenitis

Objective To evaluate the clinical value of immunohistochemistry (IHC) and polymerase chain reaction (PCR) methods in pathological diagnosis of tuberculous lymphadenitis. Methods Paraffin-embedded tissue specimens from 48 patients with tuberculous lymphadenitis who had undergone radical resection (the tuberculosis (TB) group) and 21 cases with other diseases in lymph node (the non-TB group) were collected during Jan 2012 to Jul 2013 in Beijing Chest Hospital, Capital Medical University. One-step IHC using antibody targeting Ag85B, Taqman fluorescent quantitative PCR and acid-fast staining were conducted. Their diagnostic efficiency were analyzed, taking the clinical final diagnosis as golden standard.Results The IHC and PCR showed significantly higher sensitivity than that of acid-fast staining (χ ²=6.27, P=0.012; χ ²=10.84, P=0.001, respectively), by the results of 52.1% (25/48) and 60.4% (29/48) versus 27.1% (13/48). However, there was no significant difference in sensitivity between IHC and PCR (χ ²=0.68, P=0.411). The detection results of IHC, PCR and acid-fast staining in non-TB group were all negative, with a specificity of 100% (21/21) for each test. The IHC and PCR had higher negative predictive value and accordance rate than acid-fast staining (47.7% (21/44), 52.5% (21/40), 37.5% (21/56), respectively; 66.7% (46/69), 72.5% (50/69), 49.3% (34/69), respectively). Conclusion IHC and PCR methods are simple and have higher sensitivity compared to acid-fast staining method. IHC and PCR showed good clinical application value in pathological diagnosis of tuberculous lymphadenitis.