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

doi:10.3969/j.issn.1000-6621.2018.04.002

中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (4): 348-352.doi: 10.3969/j.issn.1000-6621.2018.04.002

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

董宇杰,张莉,王宇轩,周立娟,曲杨,张晨,张海青(),车南颖()

101149 首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所病理科耐药结核病研究北京市重点实验室

收稿日期:2017-12-20 出版日期:2018-04-10 发布日期:2018-05-14
通信作者: 张海青,车南颖 E-mail:zhqing56@sina.com;cheny0448@163.com
作者简介:注:董宇杰、张莉、王宇轩对本研究具有同等贡献,为并列第一作者
基金资助:
国家自然科学基金(81572077);首都医科大学附属北京同仁医院头颈部分子病理诊断北京市重点实验室开放研究课题;北京市医院管理局临床医学发展专项(XMLX201506);北京市卫生系统高层次卫生技术人才培养计划(2014-03-082);北京市卫生系统高层次卫生技术人才培养计划(2014-03-083);首都卫生发展科研专项(2014-4-2161);北京市医院管理局登峰计划(DFL20151501);北京市科学技术委员会重点项目(D14117005214003)

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

Yu-jie DONG,Li ZHANG,Yu-xuan WANG,Li-juan ZHOU,Yang QU,Chen ZHANG,Hai-qing ZHANG(),Nan-Ying CHE()

Department of Pathology, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China

Received:2017-12-20 Online:2018-04-10 Published:2018-05-14
Contact: Hai-qing ZHANG,Nan-Ying CHE E-mail:zhqing56@sina.com;cheny0448@163.com

摘要/Abstract

摘要：

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。

关键词: 结核,淋巴结, 免疫组织化学, 聚合酶链反应, 病理学, 对比研究

Abstract:

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.

Key words: Tuberculosis,lymph node, Immunohistochemistry, Polymerase chain reaction, Pathology, Comparative study

董宇杰,张莉,王宇轩,周立娟,曲杨,张晨,张海青,车南颖. 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[J]. 中国防痨杂志, 2018, 40(4): 348-352. doi: 10.3969/j.issn.1000-6621.2018.04.002

Yu-jie DONG,Li ZHANG,Yu-xuan WANG,Li-juan ZHOU,Yang QU,Chen ZHANG,Hai-qing ZHANG,Nan-Ying CHE. Clinical application of immunohistochemistry and PCR technique in pathological diagnosis of tuberculous lymphadenitis[J]. Chinese Journal of Antituberculosis, 2018, 40(4): 348-352. doi: 10.3969/j.issn.1000-6621.2018.04.002

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参考文献 23

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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

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

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检测方法	结核组(例)		非结核组(例)		敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	符合率 (%)
检测方法	阳性	阴性	阳性	阴性	敏感度 (%)	特异度 (%)	阳性预测值(%)	阴性预测值(%)	符合率 (%)
IHC染色	25	23	0	21	52.1	100.0	100.0	47.7	66.7
荧光定量PCR	29	19	0	21	60.4	100.0	100.0	52.5	72.5
抗酸染色	13	35	0	21	27.1	100.0	100.0	37.5	49.3

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