不同细菌学与病理学检查技术对骨关节结核诊断的效能研究

doi:10.19982/j.issn.1000-6621. 20210675

中国防痨杂志 ›› 2022, Vol. 44 ›› Issue (4): 362-367.doi: 10.19982/j.issn.1000-6621. 20210675

不同细菌学与病理学检查技术对骨关节结核诊断的效能研究

苏丹¹, 车南颖¹, 欧喜超², 赵颖丽¹, 李琨¹, 陈学敬¹, 林海峰¹, 穆晶¹, 黄海荣³()

¹首都医科大学附属北京胸科医院病理科,北京101149
²中国疾病预防控制中心结核病预防控制中心,北京 102206
³首都医科大学附属北京胸科医院国家结核病临床实验室,北京101149

收稿日期:2021-11-24 出版日期:2022-04-10 发布日期:2022-04-06
通信作者: 黄海荣 E-mail:huanghairong@tb123.org
基金资助:
北京市通州区“运河”人才计划(YH201905)

Study on the diagnostic efficacy of different bacteriological and pathological examination techniques for osteoarticular tuberculosis

SU Dan¹, CHE Nan-ying¹, OU Xi-chao², ZHAO Ying-li¹, LI Kun¹, CHEN Xue-jing¹, LIN Hai-feng¹, MU Jing¹, HUANG Hai-rong³()

¹Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
²National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
³National Tuberculosis Clinical Laboratory of China, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China

Received:2021-11-24 Online:2022-04-10 Published:2022-04-06
Contact: HUANG Hai-rong E-mail:huanghairong@tb123.org
Supported by:
Canal Talent Program of Tongzhou District, Beijing(YH201905)

摘要/Abstract

摘要：

目的: 回顾性分析脓液标本细菌学检测技术和组织标本病理学检测技术诊断骨关节结核的检测效能。 方法: 以2016 年1 月至2018 年12 月在北京胸科医院住院治疗的213 例送检同部位脓液和组织标本进行检测的疑似骨关节结核患者作为研究对象,取新鲜脓液标本进行涂片染色镜检、GeneXpert MTB/RIF(GeneXpert)检测、实时荧光定量PCR(FQ-PCR)检测和BACTEC MGIT 960 液体培养(MGIT 960 液体培养);组织标本经石蜡包埋后进行抗酸染色镜检和FQ-PCR 检测。 结果: 根据骨结核临床诊断综合参考标准(CRS),186 例纳入患者诊断为骨关节结核,其中124 例为确诊结核患者,23 例为高度疑似结核患者,39 例为疑似结核患者;27 例患者排除骨关节结核。与CRS比较,脓液标本涂片镜检、MGIT 960 液体培养、FQ-PCR、GeneXpert以及组织标本抗酸染色和FQ-PCR 检测的敏感度分别为28.7% (49/171)、49.0% (48/98)、58.1% (25/43)、87.5% (161/184)、48.6%(90/185)和85.4% (146/171);特异度分别为100.0% (26/26)、11/11、8/9、96.2% (25/26)、96.3% (26/27)和100.0% (27/27)。结论: 脓液标本GeneXpert检测和组织标本FQ-PCR 检测的敏感度高,检测用时短,可用于骨关节结核的早期诊断。

关键词: 结核,骨关节, 病理学, 细菌学技术, 诊断

Abstract:

Objective: The efficacy of bacteriological technology for pus specimens and pathological technology for tissue specimens in the diagnosis of osteoarticular tuberculosis was retrospectively analyzed. Methods: The 213 suspected osteoarticular tuberculosis patients hospitalized in Beijing Chest Hospital from January 2016 to December 2018 were selected as the research objects. Pus and tissue specimens specimens of them were submitted at the same site for test. Fresh pus specimens were tested with smear staining microscopic examination, GeneXpert MTB/RIF, FQ-PCR and BACTEC MGIT 960 liquid culture test; tissue specimens were embedded in paraffin and then subjected to acid-fast staining microscopic examination and FQ-PCR. Results: According to the composite reference standard (CRS), 186 patients were diagnosed as osteoarticular tuberculosis, of which 124 were confirmed tuberculosis cases, 23 were highly suspected tuberculosis cases, 39 were suspected tuberculosis cases, 27 patients were excluded from osteoarticular tuberculosis. Compare to CRS, the sensitivities of smear microscopy, MGIT 960 liquid culture, FQ-PCR, GeneXpert MTB/RIF for pus specimens, and acid-fast staining and FQ-PCR detection for tissue specimens were 28.7% (49/171), 49.0% (48/98), 58.1% (25/43), 87.5% (161/184), 48.6% (90/185) and 85.4% (146/171); the specificities were 100.0% (26/26), 11/11, 8/9, 96.2% (25/26), 96.3% (26/27) and 100.0% (27/27). Conclusion: GeneXpert MTB/RIF examination for pus specimens and FQ-PCR examination for tissue specimens had high sensitivity and short turn-around time, they could be used for early diagnosis of osteoarticular tuberculosis.

Key words: Tuberculosis,osteoarticular, Pathology, Bacteriological techniques, Diagnosis

中图分类号:

R521
R529.2

苏丹, 车南颖, 欧喜超, 赵颖丽, 李琨, 陈学敬, 林海峰, 穆晶, 黄海荣. 不同细菌学与病理学检查技术对骨关节结核诊断的效能研究[J]. 中国防痨杂志, 2022, 44(4): 362-367. doi: 10.19982/j.issn.1000-6621. 20210675

SU Dan, CHE Nan-ying, OU Xi-chao, ZHAO Ying-li, LI Kun, CHEN Xue-jing, LIN Hai-feng, MU Jing, HUANG Hai-rong. Study on the diagnostic efficacy of different bacteriological and pathological examination techniques for osteoarticular tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(4): 362-367. doi: 10.19982/j.issn.1000-6621. 20210675

图/表 3

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表1

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参考文献 16

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患病部位	确诊患者 (124例)	高度疑似患者 (23例)	疑似患者 (39例)	排除患者 (27例)	合计 (213例)	χ²值	P值
胸椎	32(25.8)	7(30.5)	7(17.9)	4(14.8)	50(23.5)	2.786	0.426
腰椎	40(32.3)	3(13.0)	13(33.3)	10(37.1)	66(31.0)	3.736	0.291
骶髂	6(4.8)	2(8.7)	1(2.6)	0(0.0)	9(4.2)	2.278	0.457
颈椎	4(3.2)	3(13.0)	0(0.0)	0(0.0)	7(3.3)	6.020	0.057
外周骨关节	30(24.2)	4(17.4)	15(38.5)	8(29.6)	57(26.8)	4.285	0.231
四肢骨关节	12(9.7)	4(17.4)	3(7.7)	5(18.5)	24(11.2)	3.292	0.340

标本类型检测方法	疑似骨关节结核收治患者		敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	符合率 (%)
标本类型检测方法	骨关节结核	排除骨关节结核	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	符合率 (%)
脓液标本
涂片法			28.7	100.0	100.0	17.6	38.1
阳性(例)	49	0
阴性(例)	122	26
MGIT 960培养			49.0	11/11	100.0	18.0	54.1
阳性(例)	48	0
阴性(例)	50	11
FQ-PCR			58.1	8/9	96.2	30.8	63.5
阳性(例)	25	1
阴性(例)	18	8
Xpert			87.5	96.2	99.4	52.1	88.6
阳性(例)	161	1
阴性(例)	23	25
组织标本
抗酸染色			48.6	96.3	98.9	21.5	54.7
阳性(例)	90	1
阴性(例)	95	26
FQ-PCR			85.4	100.0	100.0	51.9	87.4
阳性(例)	146	0
阴性(例)	25	27

不同细菌学与病理学检查技术对骨关节结核诊断的效能研究

Study on the diagnostic efficacy of different bacteriological and pathological examination techniques for osteoarticular tuberculosis

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