抗酸杆菌荧光染色镜检的应用研究

doi:10.3969/j.issn.1000-6621.2014.04.009

中国防痨杂志 ›› 2014, Vol. 36 ›› Issue (4): 267-273.doi: 10.3969/j.issn.1000-6621.2014.04.009

抗酸杆菌荧光染色镜检的应用研究

丁北川王嫩寒张洁侯继增赵平樊国旺李国红王甦民洪峰吕尚军

100035 北京结核病控制研究所中心实验室(丁北川、王嫩寒、张洁、王甦民）、所长办公室（洪峰）；北京市通州区疾病预防控制中心结核病预防控制中心化验室（侯继增）；北京市朝阳区疾病预防控制中心结核病门诊部化验室（赵平）；北京市大兴区结核病预防控制中心化验室（樊国旺）；北京市平谷区疾病预防控制中心结核病预防控制中心化验室（李国红）；北京倍肯恒业科技发展有限责任公司市场部（吕尚军）

收稿日期:2013-08-05 出版日期:2014-04-10 发布日期:2014-05-02
通信作者: 丁北川 E-mail:bchding@163.com

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

DING Bei-chuan, WANG Nen-han, ZHANG Jie, HOU Ji-zeng, ZHAO Ping, FAN Guo-wang, LI Guo-hong, WANG Su-min, HONG Feng, Lv Shang-jun

Central Laboratory of Beijing Research Institute for Tuberculosis Control, Beijing 100035, China

Received:2013-08-05 Online:2014-04-10 Published:2014-05-02
Contact: DING Bei-chuan E-mail:bchding@163.com

摘要/Abstract

摘要： 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)－1＝1－(假阴性率+假阳性率)］。所有结果采用SPSS 17.0统计软件完成配对χ²检验，以P<0.05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 (χ²＝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-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 (χ²＝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(χ²＝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(χ²＝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-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。

关键词: 分枝杆菌属, 荧光染料, 显微镜检查, 应用研究

Abstract: 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 results 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 Z-N was 8.8% (190/2157), the difference was statistically significant between the two methods (χ²＝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 (χ²＝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 L-J culture was 15.2% (189/1245), and and there was no significant difference (χ²＝2.173, P=0.140). Among the specimens of new cases 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 (χ²＝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 39.7% (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% (82/189) and 0.537, respectively. Conclusion Compared with Z-N, 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.

Key words: Mycobacterium, Fluorescent dyes, Microscopy, Study for application

丁北川，王嫩寒，张洁，侯继增，赵平，樊国旺，李国红，王甦民，洪峰，吕尚军. 抗酸杆菌荧光染色镜检的应用研究[J]. 中国防痨杂志, 2014, 36(4): 267-273. doi: 10.3969/j.issn.1000-6621.2014.04.009

DING Bei-chuan, WANG Nen-han, ZHANG Jie, HOU Ji-zeng, ZHAO Ping, FAN Guo-wang, LI Guo-hong, WANG Su-min, HONG Feng, Lv Shang-jun. Evaluation of the application of fluorescent microscopy on detection of acid-fast bacillus[J]. Chinese Journal of Antituberculosis, 2014, 36(4): 267-273. doi: 10.3969/j.issn.1000-6621.2014.04.009

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抗酸杆菌荧光染色镜检的应用研究

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

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