摘要
目的通过不同痰检方法，调查分析北京两家综合医院呼吸科住院诊断为非肺结核患者的MTB检出率，为综合医院肺结核病原学检测能力的提高提供依据。方法选取2014年1月至2015年6月于首都医科大学附属北京同仁医院和中国中医科学院望京医院呼吸科临床诊断为其他肺部疾病（非肺结核）的住院患者830例为研究对象。根据临未诊断分为8组：肺部感染组267例，慢性阻塞性肺疾病组143例，支气管扩张合并感染组110例，慢性支气管炎急性发作组79例，肺纤维化并发感染组74例，肺部阴影待查组66例，肺癌组62例及其他未明确诊断肺部疾病组29例。通过萋-尼染色涂片镜检法（Ziehl-Neelsenstaining，Z-N染色）、MTBMGIT960快速液体培养（BACTECTM MGITTM 960 Mycobacterial Detection System,简称“MGIT960培养法”）及Xpert MTB／RIF（简称“Xpert法”）检测MTB与利福平耐药情况，培养阳性的标本经基质辅助激光解析电离飞行时间质谱技术（matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, MALDI-TOF-MS）鉴定菌种，通过16S～23SrRNA基因转录间隔区（internal transcribed spacer,ITS）测序对3种方法鉴定结果进行确认。结果830例患者经3种方法检测，MTB总检出率为6．14％（51／830）。其中老年人（≥65岁）占MTB检出者的64．71％（33／51），有糖尿病、肿瘤等疾病的患者占80．39％（41／51）。男、女患者MTB检出率分别为5．85％（34／581）、6．83％（17／249），差异无统计学意义（χ2=0．32，P=0．553）。肺部阴影待查组MTB检出率达18．18％（12／66），明显高于肺部感染组（6．74％，18／267）（χ2=8．45，P=0．004）、慢性阻塞性肺疾病组（5．59％，8／143）（χ2=8．27，P=0．004）、支气管扩张合并感染组（4．55％，5／110）（χ2=8．79，P=0．003）、慢性支气管炎急性发作组（5．06％，4／79）（χ2=5．04，
Objective To analyze the detectable rate of Mycobacterium tuberculosis （MTB） in non-TB inpa- tients from respiration department of two comprehensive hospitals in Eeijing in order to provide basis for improving capacity of MTB detection in comprehensive hospitals. Methods A total of 830 inpatients （not TB patients） from respiration department of Beijing Tongren Hospital and Wangjing Hospital between January 2014 and June 2015 were divided into 8 groups according to the diagnosis： pulmonary infection （PI, n= 267）, chronic obstructive pulmonary disease （COPD, n = 143）, bronchiectasis combined with infection （BI, n=110）, acute exacerbation of chro- nic bronchitis （AECB, n=79）, pulmonary fibrosis combined with infection （PFI, n=74）, lung shadow of unknown origin （LSUO, n=66）, pulmonary cancer （PC, n=62） and 29 patients were diagnosed with other disorders. Ziehl- Neelsen acid fast staining （Z-N）, BACTEC MGIT 960 system （MGIT） and Xpert MTB/RIF （Xpert） wer used to detect the MTB and its rifampicin resistance, and the strin dentification of positive secimen after culture was carried out using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDLTOF MS）. All the identification results were confirmed via 16S 23S rRNA ITS gene sequencing. Results The highest detectable rate of MTB using the 3 methods in all 830 inpatients was 6.14% （51/830）, among them, the rate of elders （≥65 years） was 64.71% （33/51）, and the rate of paitient combined with diabetic mellitus, tumor or other underlying diseases was 80.39%（41/51）. The detectable rates of MTB in males and females were 5.85% （34/581） and 6.83% （17/249）, showing no statistically significant （χ2 = 0.32, P= 0. 553）. In 8 groups, the detectable rate of undiagnosed pulmonary shadow group （18.18%, 12/66） significant higher than those of PI group （6.74%, 18/267） （χ2 =8.45, P=0. 004）, chronic obstructive pulmonary disease group （5.59%, 8/143） （22 =8.27,
出处
《中国防痨杂志》
CAS
2016年第7期549-554,共6页
Chinese Journal of Antituberculosis
关键词
医院
综合
呼吸疗法科
医院
结核
肺
分枝杆菌
结核
延误诊断
Hospitals, general
Respiratory therapy department, hospital
Tuberculosis, pulmonary
Mycobacterium tuberculosis
Delayed diagnosis
