摘要
【摘要】目的以MTB分离培养的结果为参考，探讨痰涂片镜检在涂阳肺结核随访患者中的疗效监测及评估其准确性。方法纳入2010年1月至2011年7月黑龙江省和浙江省各2个县（市）787例涂阳肺结核患者。收集经标准化抗结核药物治疗至2个月末的679例随访患者痰标本，开展MTB痰涂片镜检和分离培养。以MTB分离培养的结果为参考，对有培养结果的670例患者计算痰涂片镜检用于疗效监测的敏感度和特异度，以评估痰涂片镜检对疗效监测的准确性。结果679例随访患者抗结核药物治疗2个月末，痰涂片镜检结果有522例（76．9％）发生阴转，其中初治患者454例（454／578，78．5％）痰涂片镜检阴转，高于复治患者[68例（68／101，67．3％）]，二者差异有统计学意义（x^2=6．09，P=0．014）。670例患者治疗至2个月末分离培养结果有582例（86．9％）阴性，其中初治患者502例（502／569，88．2％），复治患者80例（80／10，79．2％），二者分离培养阴转率的差异有统计学意义（x^2=6．11，P=0．013）。以分离培养结果为参考标准，治疗至2个月末痰涂片镜检的敏感度和特异度分别为69．3％（61／88，95％CI：59．7％～78．9％）和83．7％（487／582，95％CI：80．7％～86．7％）。其中，初治患者的敏感度和特异度分别为64．2％（43／67，95％CI：52．7％～75．7％）和84．1％（422／502，95％CI：80．9％～87．3％）；复治患者分别为85．7％（18／21，95％CI：70．7％～100．OYoo）和81．3％（65／80，95％CI：72．8％～89．8％）；治疗至2个月末痰涂片镜检对初治与复治患者疗效监测的敏感度、特异度差异均无统计学意义（x^2=3．28，P=0．070；x^2=0．40，P=0．527）。结论在结核病治疗过程中应用痰涂片镜检进行疗效监测的敏感度和特异度均较低，应结合分离培养技术提高其准确性。
Objective By comparing with culture results of Mycobacterium tuberculosis （MTB）, to evaluate the performance of smear microscopy on assessment of response to anti tuberculosis （TB） treatment in patients with smeappositive pulmonary TB. Methods A total of 787 smear-positive pulmonary TB patients were recruited during the period from January 2010 to July 2011 in four counties in Heilongjiang and Zhejiang provinces. The sputum specimens were collected from 679 patients who completed 2 months of standardized anti TB treatment and then cul- ture and smear microscopy were performed to all specimens. The sensitivity and specificity of smear microscopy for monitoring the response to anti-TB treatment were determined by comparing with the culture results of 670 patients whose culture results were obtained. Results Out of 679 patients, 522 （76.9%） cases were smear microscopy converted. The proportion of smear microscopy conversion was 78.5 % （454/578） among new cases, which was sig- nificantly higher than that among previously treated cases （67.3 % （68/101 ） ） （x^2=6.09, P= 0.014）. Among 670 cases with culture results at the end of 2 months of treatment, 582 （85.7%） cases were culture converted. The cul ture conversion rate among new cases （502/569, 88.2%） was significantly higher than that （80/101, 79.2%） among previously treated cases （x^2= = 6.11, P 0. 013）. The sensitivity and specificity of smear microscopy for mo- nitoring the response to anti TB treatment at the end of 2 months of treatment were 69.3% （61/88, 95%（71, 59.7% 78.9%） and 83.7% （487/582, 95%CI, 80.7% -86.7%） respectively in comparison with culture. The sensitivity and specificity of smear microscopy among new cases were 64.2G （43/67, 95GCI： 52.7%--75.7%） and 84.1 % （422/502, 95 % CI： 80.9 %0--87.3 %） respectively while the sensitivity and specificity among previously treated cases were 85.7% （18/21, 95%CI; 70.7%-100.0%） and 81.3% （65/80, 95%CI： 72. 8%-89. 8%） respectively. There
出处
《中国防痨杂志》
CAS
2016年第9期736-741,共6页
Chinese Journal of Antituberculosis
基金
基金名称：“十二五”国家科技重大专项（2014ZX10003002）
关键词
结核
肺
痰/显微镜检查
细菌学技术
治疗结果
评价研究
Tuberculosis, pulmonary
Sputum/microscopy
Bacteriological techniques
Treatmentoutcome
Evaluation study
