Chinese Journal of Antituberculosis ›› 2018, Vol. 40 ›› Issue (4): 365-371.doi: 10.3969/j.issn.1000-6621.2018.04.005
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Gui-rong WANG,Shu-qi WANG,Guang-lu JIANG,Mai-ling HUANG,Xin-ting YANG,Xiao-you CHEN,Hai-rong HUANG()
Received:
2017-08-28
Online:
2018-04-10
Published:
2018-05-14
Contact:
Hai-rong HUANG
E-mail:huanghairong@tb123.org
Gui-rong WANG,Shu-qi WANG,Guang-lu JIANG,Mai-ling HUANG,Xin-ting YANG,Xiao-you CHEN,Hai-rong HUANG. Diagnostic value of combined detection of sputum and pleural effusion with different techniques in tuberculous pleurisy[J]. Chinese Journal of Antituberculosis, 2018, 40(4): 365-371. doi: 10.3969/j.issn.1000-6621.2018.04.005
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特征 | 合计 (1955例) | 有肺部实质病变 (1232例) | 无肺部实质病变 (723例) | χ2值 | P值 |
---|---|---|---|---|---|
性别 | 1.49 | 0.223 | |||
男 | 1392(71.20) | 889(72.16) | 503(69.57) | ||
女 | 563(28.80) | 343(27.84) | 220(30.43) | ||
年龄组(岁) | |||||
8~ | 235(12.02) | 152(12.34) | 83(11.48) | 0.32 | 0.573 |
21~ | 597(30.54) | 378(30.68) | 219(30.29) | 0.03 | 0.856 |
31~ | 242(12.38) | 138(11.20) | 104(14.38) | 4.26 | 0.039 |
41~ | 241(12.32) | 148(12.01) | 93(12.86) | 0.31 | 0.581 |
51~ | 240(12.28) | 155(12.58) | 85(11.76) | 0.29 | 0.592 |
60~ | 400(20.46) | 261(21.19) | 139(19.23) | 1.08 | 0.300 |
民族 | 2.46 | 0.117 | |||
汉族 | 1811(92.63) | 1150(93.34) | 661(91.42) | ||
少数民族 | 144(7.37) | 82(6.66) | 62(8.58) | ||
职业 | |||||
农民 | 624(31.92) | 391(31.74) | 233(32.23) | 0.05 | 0.823 |
工人 | 186(9.51) | 113(9.17) | 73(10.10) | 0.45 | 0.501 |
学生 | 207(10.59) | 131(10.63) | 76(10.51) | 0.01 | 0.933 |
退(离)休人员 | 345(17.65) | 221(17.94) | 124(17.15) | 0.19 | 0.659 |
其他 | 593(30.33) | 376(30.52) | 217(30.01) | 0.06 | 0.814 |
并发其他疾病a | |||||
高血压 | 205(10.49) | 113(9.17) | 92(12.72) | 6.13 | 0.013 |
糖尿病 | 311(15.91) | 219(17.78) | 92(12.72) | 8.69 | 0.003 |
类风湿性关节炎 | 17(0.87) | 10(0.81) | 7(0.97) | 0.13 | 0.719 |
肿瘤 | 33(1.69) | 14(1.14) | 19(2.63) | 6.11 | 0.013 |
肾功能不全 | 41(2.10) | 29(2.35) | 12(1.66) | 1.07 | 0.301 |
贫血 | 291(14.88) | 216(17.53) | 75(10.37) | 18.43 | <0.01 |
检测方法 检测标本 | 有肺部实质病变 | 无肺部实质病变 | χ2值 | P值 | ||
---|---|---|---|---|---|---|
检测例数 | 阳性[例 (阳性率,%)] | 检测例数 | 阳性[例 (阳性率,%)] | |||
涂片法(535例) | 340 | 195 | ||||
胸腔积液 | 13(3.82) | 4(2.05) | 1.27 | 0.261 | ||
痰液 | 103(30.29) | 4(2.05) | 61.78 | <0.01 | ||
胸腔积液+痰液 | 109(32.06) | 8(4.10) | 56.68 | <0.01 | ||
培养法(353例) | 227 | 126 | ||||
胸腔积液 | 37(16.30) | 17(13.49) | 0.64 | 0.424 | ||
痰液 | 116(51.10) | 13(10.32) | 51.04 | <0.01 | ||
胸腔积液+痰液 | 127(55.95) | 27(21.43) | 33.41 | 0.01 | ||
Xpert法(294例) | 184 | 110 | ||||
胸腔积液 | 44(23.91) | 12(10.91) | 6.09 | 0.014 | ||
痰液 | 111(60.33) | 4(3.64) | 68.75 | <0.01 | ||
胸腔积液+痰液 | 125(67.93) | 15(13.64) | 54.21 | <0.01 |
检测方法 | 检测标本 | 敏感度(%) | 特异度(%) | 阳性预测值(%) | 阴性预测值(%) |
---|---|---|---|---|---|
涂片法(279例) | 胸腔积液 | 8.20(10/122) | 99.36(156/157) | 90.91(10/11) | 58.21(156/268) |
痰液 | 45.90(56/122) | 96.82(152/157) | 91.80(56/61) | 69.72(152/218) | |
胸腔积液+痰液 | 48.36(59/122) | 96.18(151/157) | 90.77(59/65) | 70.56(151/214) | |
Xpert法(208例) | 胸腔积液 | 26.80(26/97) | 85.59(95/111) | 61.90(26/42) | 57.23(95/166) |
痰液 | 69.07(67/97) | 82.88(92/111) | 77.91(67/86) | 75.41(92/122) | |
胸腔积液+痰液 | 79.38(77/97) | 73.87(82/111) | 72.64(77/106) | 80.39(82/102) | |
涂片法+Xpert法(177例) | 胸腔积液 | 26.83(22/82) | 87.37(83/95) | 64.71(22/34) | 58.04(83/143) |
痰液 | 73.17(60/82) | 81.05(77/95) | 76.92(60/78) | 77.78(77/99) | |
胸腔积液+痰液 | 80.49(66/82) | 73.68(70/95) | 72.53(66/91) | 81.40(70/86) |
[1] | World Health Organization. Global tuberculosis report 2017. Geneva: World Health Organization, 2017. |
[2] |
Light RW . Update on tuberculous pleural effusion. Respirology, 2010,15(3):451-458.
doi: 10.1111/j.1440-1843.2010.01723.x URL pmid: 20345583 |
[3] | Thomas R, Lee YC. Causes and management of common benign pleural effusions. Thorac Surg Clin, 2013, 23(1):25-42, v-vi. |
[4] |
Tyagi S, Sharma N, Tyagi JS , et al. Challenges in pleural tuberculosis diagnosis: existing reference standards and nucleic acid tests. Future Microbiol, 2017,12:1201-1218.
doi: 10.2217/fmb-2017-0028 URL |
[5] |
孔忠顺, 刘京铭, 高孟秋 . 结核性胸膜炎诊断的研究进展. 中国防痨杂志, 2016,38(4):327-330.
doi: 10.3969/j.issn.1000-6621.2016.04.020 URL |
[6] | Ruan SY, Chuang YC, Wang JY , et al. Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax, 2012,67(9):822-827. |
[7] |
Ko JM, Park HJ, Kim CH . Pulmonary changes of pleural TB: up-to-date CT imaging. Chest, 2014,146(6):1604-1611.
doi: 10.1378/chest.14-0196 URL |
[8] |
Porcel JM . Advances in the diagnosis of tuberculous pleuritis. Ann Transl Med, 2016,4(15):282.
doi: 10.21037/atm.2016.07.23 URL pmid: 4980363 |
[9] | 中华医学会. 临床诊疗指南:结核病分册. 北京:人民卫生出版社, 2005: 10-12. |
[10] |
Marchiori E, Zanetti G, Barreto MM , et al. Atypical distribution of small nodules on high resolution CT studies: patterns and differentials. Respir Med, 2011,105(9):1263-1267.
doi: 10.1016/j.rmed.2011.02.010 URL pmid: 21377343 |
[11] | 中国防痨协会基础专业委员会. 结核病诊断实验室检验规程. 北京: 中国教育文化出版社, 2006. |
[12] | Makeshkumar V, Madhavan R, Narayanan S . Polymerase chain reaction targeting insertion sequence for the diagnosis of extrapulmonary tuberculosis. Indian J Med Res, 2014,139(1):161-166. |
[13] |
Sehgal IS, Dhooria S, Aggarwal AN , et al. Diagnostic performance of Xpert MTB/RIF in tuberculous pleural effusion: systematic review and Meta-analysis. J Clin Microbiol, 2016,54(4):1133-1136.
doi: 10.1128/JCM.03205-15 URL |
[14] | Du J, Huang Z, Luo Q , et al. Rapid diagnosis of pleural tuberculosis by Xpert MTB/RIF assay using pleural biopsy and pleural fluid specimens. J Res Med Sci, 2015,20(1):26-31. |
[15] | 杨新婷, 关国英, 王亚红 , 等. 结核性胸膜炎的临床特征及诊断技术分析. 中国防痨杂志, 2017,39(11):1163-1169. |
[16] |
Valdés L, Ferreiro L, Cruz-Ferro E , et al. Recent epidemiological trends in tuberculous pleural effusion in Galicia, Spain. Eur J Intern Med, 2012,23(8):727-732.
doi: 10.1016/j.ejim.2012.06.014 URL pmid: 22818626 |
[17] |
Levine H, Metzger W, Lacera D , et al. Diagnosis of tuberculous pleurisy by culture of pleural biopsy specimen. Arch Intern Med, 1970,126(2):269-271.
doi: 10.1001/archinte.126.2.269 URL pmid: 4988357 |
[18] |
Marjani M, Yousefzadeh A, Tabarsi P , et al. Yield of mycobacteriological study in diagnosis of pleural tuberculosis among Human immune deficiency virus-infected patients. Int J Mycobacteriol, 2016,5 Suppl 1: S112-S113.
doi: 10.1016/j.ijmyco.2016.09.043 URL |
[19] |
Machado T, Fonseca AJ, Buenafuente SM . Pleural tuberculosis in the state of Roraima, Brazil, between 2005 and 2013: quality of diagnosis. J Bras Pneumol, 2016,42(2):106-113.
doi: 10.1590/S1806-37562015000000082 URL |
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