发光二极管荧光显微镜检测结核分枝杆菌在基层实验室的应用评价

doi:10.3969/j.issn.1000-6621.2014.07.002

中国防痨杂志 ›› 2014, Vol. 36 ›› Issue (7): 525-529.doi: 10.3969/j.issn.1000-6621.2014.07.002

发光二极管荧光显微镜检测结核分枝杆菌在基层实验室的应用评价

宋媛媛蒋明霞郭占清夏辉赵雁林

102206 北京，中国疾病预防控制中心结核病预防控制中心国家结核病参比实验室（宋媛媛、夏辉、赵雁林）；青海省疾病预防控制中心传染病预防控制所结核病防治科（蒋明霞）；青海省西宁市疾病预防控制中心结核科（郭占清）

收稿日期:2014-04-14 出版日期:2014-07-10 发布日期:2014-08-07
通信作者: 赵雁林 E-mail:zhaoyanlin@chinatb.org
基金资助:
比利时达米恩基金会结核病防治项目（2011-02-01）

Evaluation of fluorescent microscopic with light-emitting diodes in detecting Mycobacterium tuberculosis in laboratories based basic-level

SONG Yuan-yuan, JIANG Ming-xia, GUO Zhan-qing, XIA Hui, ZHAO Yan-lin

National Tuberculosis Reference Laboratory, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention，Beijing 102206, China

Received:2014-04-14 Online:2014-07-10 Published:2014-08-07
Contact: ZHAO Yan-lin E-mail:zhaoyanlin@chinatb.org

摘要/Abstract

摘要： 目的评价发光二极管（light-emitting diodes，LED）荧光显微镜在基层实验室痰涂片中检测结核分枝杆菌的应用效果。方法收集2011年7月至2011年9月在青海省西宁市7个县（区）级结核病防治机构（简称“结防机构”）就诊的所有肺结核可疑症状者592例（1738份痰标本）。对每份痰标本涂片2张，分别进行萋-尼（Ziehl-Neelsen, Z-N）抗酸染色和金胺O(auramine O)荧光染色，然后以盲法用传统光学显微镜和LED荧光显微镜进行检测，以简单法固体罗氏培养(L-J)结果为金标准，比较两种显微镜阳性检出率的差异、诊断的准确性及检出时间的差异。结果 LED荧光显微镜痰涂片阳性检出率为14.90%（259/1738），比传统光学显微镜13.75%（239/1738）提高1.15%，差异有统计学意义（Z=5.88，P<0.05）。以简单法固体罗氏培养结果为金标准，传统光学显微镜的敏感度为79.60%（199/250；95%CI=74.60％～84.60%），特异度为97.31%（1446/1486；95%CI=96.49％～98.13%）；ROC曲线下面积为0.8878(95%CI=0.8623～0.9133)。LED荧光显微镜的敏感度为84.80%（212/250；95%CI=80.30%～89.25%），特异度为96.84%（1439/1486；95%CI=95.95%～97.73%），ROC曲线下面积为0.9118(95%CI=0.8890～0.9347)。传统光学显微镜的平均读片时间为（185.600±79.271）s，LED荧光显微镜的平均读片时间为（144.19±62.173）s，时间差异有统计学意义（t=15.32, P<0.01）。结论应用LED荧光显微镜可明显提高痰涂片中结核分枝杆菌的阳性检出率，较传统光学显微镜有更高的敏感度，但特异度相当，诊断肺结核患者的价值更高，且能明显缩短读片时间。

关键词: 分枝杆菌, 结核, 显微镜检查, 荧光

Abstract: Objective To evaluate the application effects of fluorescent microscopes with light-emitting diodes (LED-FM) in detecting Mycobacterium tuberculosis (Mtb) in sputum samples in laboratories based basic-level. Methods One thousand seven hundred and thirty-eight sputum samples were collected from 592 pulmonary tuberculosis (TB) suspects who were detected by seven county TB dispensaries in Xining city of Qinghai province from July 2011 to September 2011. Two smears were prepared for each sputum specimen and then stained by Ziehl-Neelsen and auramine O respectively. The smear specimens stained by Ziehl-Neelsen were read by using conventional light microscope (CLM) while the specimens stained by auramine O were read by using LED-FM, and the results were recorded. Culture on solid Lowenstein-Jensen (L-J) media was also performed for all collected sputum samples and the culture result was used as a gold standard for comparison of smear-positive rate tested by two different types of microscopes; the veracity of diagnosis and diagnosis time by using the two methods were also compared. Results The smear-positive rate was 14.90% (259/1738) by using LED-FM, which was 1.15% higher than that of 13.75% (239/1738) by using CLM (Z=5.88, P<0.05). With L-J culture as the gold standard, the sensitivity, specificity and the area under the curve (AUC) of CLM in detecting TB patients were 79.60% (199/250; 95%CI＝74.60%-84.60%), 97.31% (1446/1486; 95%CI＝96.49%-98.13%) and 0.8878 (95%CI＝0.8623-0.9133); the sensitivity, specificity and AUC of LED-FM were 84.80% (212/250; 95%CI=80.30%-89.25%), 96.84% (1439/1486; 95%CI＝95.95%-97.73%) and 0.9118 (95%CI＝0.8890-0.9347). The reading time by LED-FM and CLM was (144.19±62.173) s and (185.600±79.271) s respectively; the difference of the reading time was significant (t=15.32, P<0.01). Conclusion If LED-FM is used for TB diagnosis, the smear-positive rate of sputum samples can be increased significantly. Compared with CLM, LED-FM has higher sensitive and similar specificity in detecting TB patients. So it is concluded that the application of LED-FM has higher value in detection of pulmonary TB, and it can also shorten the reading time of sputum smear slides.

Key words: Mycobacterium tuberculosis, Microscopy, fluorescence

宋媛媛，蒋明霞，郭占清，夏辉，赵雁林. 发光二极管荧光显微镜检测结核分枝杆菌在基层实验室的应用评价[J]. 中国防痨杂志, 2014, 36(7): 525-529. doi: 10.3969/j.issn.1000-6621.2014.07.002

SONG Yuan-yuan, JIANG Ming-xia, GUO Zhan-qing, XIA Hui, ZHAO Yan-lin. Evaluation of fluorescent microscopic with light-emitting diodes in detecting Mycobacterium tuberculosis in laboratories based basic-level[J]. Chinese Journal of Antituberculosis, 2014, 36(7): 525-529. doi: 10.3969/j.issn.1000-6621.2014.07.002

参考文献

［1］Steingart KR,Henry M,Ng V,et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis:a syste-matic review. Lancet Infect Dis,2006,6(9):570-581.
［2］Cuevas LE, Al-Sonboli N, Lawson L,et al. LED fluorescence microscopy for the diagnosis of pulmonary tuberculosis: a multi-country cross-sectional evaluation.PLoS Med，2011,8(7):e1001057.
［3］Chaidir L, Parwati I, Annisa J, et al. Implementation of LED fluorescence microscopy for diagnosis of pulmonary and HIV-associated tuberculosis in a hospital setting in Indonesia.PLoS One，2013，8(4):e61727.
［4］World Health Organization. Fluorescent light-emitting diode (LED) microscopy for diagnosis of tuberculosis policy. WHO/HTM/TB/2011.8. http://whqlibdoc.who.int/publications/2011/9789241501613_eng.pdf?ua=1.
［5］Khatun Z, Kamal M, Roy CK, et al. Usefulness of light emitting diode (LED) fluorescent microscopy as a tool for rapid and effective method for the diagnosis of pulmonary tuberculosis. Bangladesh Med Res Counc Bull,2011，37(1):7-10.
［6］赵雁林.痰涂片显微镜检查标准化操作及质量保证手册.北京：中国协和医科大学出版社，2009:7.
［7］赵雁林. 分枝杆菌分离培养标准化操作程序及质量保证手册.北京：人民卫生出版社，2013:4.
［8］余松林.医学统计学.北京:人民卫生出版社,2002.
［9］Trusov A, Bumgarner R, Valijev R,et al.Comparison of lu-min LED fluorescent attachment, fluorescent microscopy and Ziehl-Neelsen for AFB diagnosis. Int J Tuberc Lung Dis，2009，13(7):836-841.
［10］Habtamu M, van den Boogaard J, Ndaro A, et al. Light-emitting diode with various sputum smear preparation techniques to diagnose tuberculosis. Int J Tuberc Lung Dis，2012，16(3):402-407.
［11］Xia H, Song YY, Zhao B, et al. Multicentre evaluation of Ziehl-Neelsen and light-emitting diode fluorescence microscopy in China.Int J Tuberc Lung Dis，2013，17(1):107-112.
［12］Khatun Z, Kamal M, Roy CK,et al.Usefulness of light emitting diode (LED) fluorescent microscopy as a tool for rapid and effective method for the diagnosis of pulmonary tuberculosis.Bangladesh Med Res Counc Bull，2011，37(1):7-10.
［13］Bonnet M, Gagnidze L, Githui W,et al. Performance of LED-based fluorescence microscopy to diagnose tuberculosis in a peripheral health centre in Nairobi.PLoS One, 2011,6(2):e17214.
［14］International Union Against Tuberculosis and Lung Disease(IUATLD) technical guide.Sputum examination for tuberculosis by direct microscopy in low-income countries.5th ed. Paris: IUATLD,2000.
［15］Cambanis A, Ramsay A, Wirkom V,et al.Investing time in microscopy: an opportunity to optimise smear-based case detection of tuberculosis.Int J Tuberc Lung Dis，2007，11(1):40-45.

发光二极管荧光显微镜检测结核分枝杆菌在基层实验室的应用评价

Evaluation of fluorescent microscopic with light-emitting diodes in detecting Mycobacterium tuberculosis in laboratories based basic-level

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