摘要
目的探讨恒温扩增实时荧光检测(SAT)快速诊断结核性脑膜炎(TBM)的临床价值。方法选取疑似中枢神经系统感染患者496例,其中328例最终临床诊断为TBM(TBM组),另外168例经临床鉴别诊断排除TBM(对照组)。分别采用培养法、聚合酶链反应(PCR)和SAT同时检测2组患者脑脊液样本,比较3种方法检测结核分枝杆菌(MTB)的效能。结果以临床诊断TBM为标准,SAT检测脑脊液样本MTB的敏感性(15.24%)高于培养法(11.28%)(χ^2=2.24,P>0.05)和PCR(6.71%)(χ^2=12.23,P<0.05);特异性(99.40%)略低于培养法和PCR(均为100%)(χ^2=1.00,P>0.05)。以培养法为标准,TBM组SAT检测脑脊液MTB的敏感性(37.84%)高于PCR(21.62%),特异性(87.63%)和符合率(82.01%)低于PCR(95.19%和86.89%)。培养法与SAT比较,MTB阳性检出率差异无统计学意义(χ^2=2.24,P>0.05);与PCR比较,差异有统计学意义(χ^2=4.19,P<0.05)。结论SAT可快速检测脑脊液中的MTB,敏感性高于培养法和PCR,有助于TBM的早期诊断。3种方法联合检测可提高脑脊液MTB的阳性检出率。
Objective To investigate the clinical role of simultaneous amplification and testing(SAT)in the diagnosis of tubercular meningitis(TBM).Methods A total of 496 suspected patients diagnosed central nervous system infection were enrolled.Among them,328 patients who were clinically diagnosed as TBM were enrolled as TBM group,while the remaining 168 patients who were clinically excluded were enrolled as control group.The cerebrospinal fluid specimens were collected and analyzed by L-J culture method,nucleic acid polymerase chain reaction(PCR)and SAT.The efficiencies of the 3 methods in detecting Mycobacterium tuberculosis(MTB)were compared.Results Taking the clinical diagnosis of TBM as gold standards,the sensitivity and specificity of SAT in detecting MTB were 15.24%and 99.40%,respectively,the sensitivity of SAT was higher than those of L-J culture method(11.28%)(χ^2=2.24,P>0.05)and PCR(6.71%)(χ^2=12.23,P<0.05).The specificity of SAT was lower than those of L-J culture method and PCR(100%)(χ^2=1.00,P>0.05).Taking L-J culture method as gold standards,in TBM group,the sensitivity,specificity and consistency rate of SAT were 37.84%,87.63%and 82.01%,respectively.The sensitivity of SAT was higher than that of PCR(21.62%),while the specificity and consistency rate were lower than those of PCR(95.19%and 86.89%).The MTB positive detection rate of L-J culture method had no statistical significance with that of SAT(χ^2=2.24,P>0.05),but had statistical significance with that of PCR(χ^2=4.19,P<0.05).Conclusions SAT can rapidly detect MTB in cerebrospinal fluid,its sensitivity is higher than those of L-J culture method and PCR and it can provide a reference for the early diagnosis of TBM.The combined detection of the 3 methods can improve the positive detection rate of MTB in cerebrospinal fluid specimens.
作者
欧维正
秦万
王琼
王明栋
张娟
徐勇
张廷梅
OU Weizheng;QIN Wan;WANG Qiong;WANG Mingdong;ZHANG Juan;XU Yong;ZHANG Tingmei(Guiyang Public Health Treatment Center,Guiyang 550003,Guizhou,China)
出处
《检验医学》
CAS
2020年第11期1169-1172,共4页
Laboratory Medicine
基金
贵阳市科技计划项目(筑科合同﹝2018﹞1-41号)。
关键词
核酸扩增技术
结核分枝杆菌
结核性脑膜炎
评价研究
Nucleic acid amplification technique
Mycobacterium tuberculosis
Tubercular meningitis
Efficiency evaluation
