关键词: 结核, 淋巴结, 颈, 核酸扩增技术, DNA探针, 诊断, 结核, 抗多种药物性

Abstract:

Objective To evaluate the clinical application value of molecular pathological methods in the diagnosis of cervical lymph node tuberculosis and its drug resistance.Methods Ninety-seven paraffin-embedded cervical lymph node specimens with tuberculosis (the tuberculosis (TB) group) and 20 specimens with other diseases (the non-TB group) were collected between March 2010 and October 2013 from the Beijing Chest Hospital. Ziehl-Neelsen (Z-N) staining and fluorescent quantitative polymerase chain reaction (FQ-PCR) were both performed on each specimen. Diagnostic efficiency of both methods was analyzed, Rifampin (RFP) and isoniazid (INH) resis-tances were detected by probe melting curve PCR.Results The sensitivities of Z-N staining and FQ-PCR were 22.7% (22/97), 67.0% (65/97), respectively. FQ-PCR showed significantly higher sensitivity than that of Z-N staining (χ²=38.53, P<0.001). The specificities of these two techniques were both 100.0% (20/20). The positive predictive values of the Z-N staining and FQ-PCR were 100.0% (22/22) and 100.0% (65/65), respectively, the negative predictive values were 21.1% (20/95) and 38.5% (20/52), respectively, and the coincidence rates were 35.9% (42/117) and 72.6% (85/117). Among 41 FQ-PCR positive TB samples, effective RFP and INH genotypic drug sensitivity test results were obtained in 10 and 27 samples, respectively, including 1 RFP resistant case and 13 INH resistant cases. Conclusion Molecular pathological techniques showed high sensitivity and specificity in detecting Mycobacterium tuberculosis DNA in FFPE specimens of cervical lymph node tuberculosis. Furthermore, the new techniques made it possible for pathological diagnosis of drug-resistant tuberculosis, and it can provide valuable evidences for accurate diagnosis and appropriate treatment.

Key words: Tuberculosis, lymph node, Neck, Nucleic acid amplification techniques, DNA Probes, Diagnosis, Tuberculosis, multidrug-resistant