Background Early detection of pulmonary tuberculosis （PTB） is a big challenge in smear negative and sputum scarce patients in China.Simultaneous amplification and testing methods for detection of the Mycobactedum tu...Background Early detection of pulmonary tuberculosis （PTB） is a big challenge in smear negative and sputum scarce patients in China.Simultaneous amplification and testing methods for detection of the Mycobactedum tuberculosis （MTB） complex （SAT-TB assay） is a novel molecular technique established in our hospital.This method has a high sensitivity and specificity in the lab.In this study,the clinical diagnostic performance of this method in smear-negative or sputum-scarce PTB suspects was investigated and evaluated.Methods Two hundred smear negative and 80 sputum-scarce patients were recruited in this study.Samples that included sputum or bronchial washing fluid were collected and sent for both bacteria culture and SAT-TB assay.Diagnosis for these patients was based on the comprehensive evaluation of chestX-ray/CT study,histology examination,lab results,and treatment response.Sensitivity,specificity,positive predictive value （PPV） and negative predictive value （NPV） for each diagnostic test were investigated and calculated using confirmed tuberculosis （TB） and non-TB cases.The time required for detection of MTB was also measured for each method.Results Ninety-two patients （33％） were diagnosed as definitive TB,112 patients （40％） were probable PTB,and 76 （27％） were non-TB.The sensitivity,specificity,PPV,and NPV of SAT-TB in smear-negative PTB suspects were 93％ （95％ CI,84％-98％）,98％ （95％ CI,90％-100％）,98％ （95％ Cl,91％-100％）,and 93％ （95％ CI,83％-98％）.In sputum scarce PTB suspects,the sensitivity,specificity,PPV,and NPV of the SAT-TB assay on bronchial washing fiuids were 90％ （95％Cl,74％-98％）,100％ （95％ Cl,85％-100％）,100％ （95％ Cl,88％-100％）,and 88％ （95％ CI,69％-97％）.The accuracy of the SAT-TB assay is consistent with the bacteria culture assay.The median time required for detecting MTB in the SAT-TB assay was 0.5 day,which was much faster than bacteria culture （28 days）.Conclusions The SA展开更多
Background:Quick diagnosis of smear-negative pulmonary tuberculosis(TB)and extra-pulmonary TB are urgently needed in clinical diagnosis.Our research aims to investigate the usefulness of the interferon-γrelease assay...Background:Quick diagnosis of smear-negative pulmonary tuberculosis(TB)and extra-pulmonary TB are urgently needed in clinical diagnosis.Our research aims to investigate the usefulness of the interferon-γrelease assay(IGRA)for the diagnosis of smear-negative pulmonary and extra-pulmonary TB.Methods:We performed TB antibody and TB-IGRA tests on 389 pulmonary TB patients(including 120 smear-positive pulmonary TB patients and 269 smear-negative pulmonary TB patients),113 extra-pulmonary TB patients,81 patients with other pulmonary diseases and 100 healthy controls.Blood samples for the TB-Ab test and the TB-IGRA were collected,processed,and interpreted according to the manufacturer’s protocol.Results:The detection ratio of smear-positive pulmonary TB patients and smear-negative pulmonary TB patients were 90.8%(109 of 120)and 89.6%(241 of 269),respectively.There was no statistically significant difference of its performance between these two sample sets(P>0.05).The detection ratio of positive TB patients and extra-pulmonary TB patients were 90.0%(350 of 389)and 87.6%(99 of 113),respectively,which was not significantly different(P>0.05).Conclusions:In this work,the total detection ratio using TB-IGRA was 89.4%,therefore TB-IGRA has diagnostic values in smear-negative pulmonary TB and extra-pulmonary TB diagnosis.展开更多
Background The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography （CT） and clinical finding...Background The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography （CT） and clinical findings in predicting smear- negative pulmonary tuberculosis in AIDS patients. Methods A total of 121 AIDS patients suspected of smear-negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 （47.1%） patients. The CT and clinical predictors were selected to diagnose AIDS-related pulmonary tuberculosis through univariate and multivariate Logistic analysis. Results Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, Iobular consolidation, tree-in-bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut-off point in the diagnosis of AIDS-related smear-negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively. Conclusion The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear-negative pulmonary tuberculosis in AIDS patients.展开更多
目的通过对比分析常规剂量和低剂量MSCT扫描对涂阴活动性肺结核CT征象的检出与显示,探讨低剂量MSCT扫描对涂阴活动性肺结核的诊断价值。方法选择我院2009年1月～2012年12月诊治的涂阴活动性肺结核48例,同时进行常规剂量180 m As和低剂量...目的通过对比分析常规剂量和低剂量MSCT扫描对涂阴活动性肺结核CT征象的检出与显示,探讨低剂量MSCT扫描对涂阴活动性肺结核的诊断价值。方法选择我院2009年1月～2012年12月诊治的涂阴活动性肺结核48例,同时进行常规剂量180 m As和低剂量30 m As MSCT扫描,对比分析两种扫描方法对肺结核基本CT征象的检出率、细节显示及扫描剂量等相关资料。结果两种扫描方案对涂阴活动性肺结核基本CT征象检出率、细节显示无显著性差异。低剂量扫描的平均X线辐射剂量为（0.94±0.04）m Sv,明显低于常规扫描的（6.24±0.26）m Sv（P〈0.05）。结论低剂量与常规剂量MSCT扫描对肺结核基本CT征象的检出及显示具有相同价值,辐射剂量大幅降低,适用于涂阴活动性肺结核诊断和鉴别诊断。展开更多
Background： Direct ZN （Ziehl-Neelsen） sputum smear microscopy for diagnosis of TB （tuberculosis） has low sensitivity, especially in TB/HIV co-infected patients. Sputum concentration by bleach （NaOCI） with sedim...Background： Direct ZN （Ziehl-Neelsen） sputum smear microscopy for diagnosis of TB （tuberculosis） has low sensitivity, especially in TB/HIV co-infected patients. Sputum concentration by bleach （NaOCI） with sedimentation has been used to increase the sensitivity of sputum smear microscopy in many settings but with varying results. Objective： To determine whether bleach plus centrifugation significantly improves the detection of AFB （acid-fast bacilli） in ZN smear-negative sputum specimens. Methods： Three hundred and seventy sputum specimens were collected from new TB suspects attending a Nairobi referral district hospital and processed for direct microscopy using ZN technique and culture on Lowenstein Jensen Media. All smear-negative specimens were treated with 3.5% bleach and left to stand for 30 min before centrifugation. The bleach treated smears were processed and examined using ZN technique. Results： Of the 370 specimens, 200 （54%） were positive culture. The number of sputum samples that were smear-positive by direct ZN was 138 （37.2%）, with a sensitivity of 66%. After treatment of direct ZN smear-negative specimens with 3.5% bleach and centrifugation, the total number of AFB smear-positive samples increased to 171 with an increase in sensitivity of 66% to 81.1% （15.1%）. Conclusion： In this study, bleach with centrifugation significantly increased the yield of sputum smear microscopy. Further evaluation of these techniques in routine programmes is required especially in settings where the burden of TB/HIV is high.展开更多
目的:探讨菌阴肺结核的临床诊断与治疗,为菌阴肺结核的控制工作提供临床依据。方法:回顾分析126例菌阴肺结核患者的临床资料,分析其临床表现、实验室相关检查及肺CT表现。结果:126例患者的症状和体征无特异性。126例患者中,结核分枝杆...目的:探讨菌阴肺结核的临床诊断与治疗,为菌阴肺结核的控制工作提供临床依据。方法:回顾分析126例菌阴肺结核患者的临床资料,分析其临床表现、实验室相关检查及肺CT表现。结果:126例患者的症状和体征无特异性。126例患者中,结核分枝杆菌纯蛋白衍化物(purified protein derivative of tuberculin.PPD)试验(++)68例,(+++)30例,(-)26例,(+)2例;结核抗体试验(immunochroma-tographic test,ICT)阳性39例;腺苷脱氨酶升高45例,血沉升高47例,C-反应蛋白升高20例;肺CT检查显示,病灶累及1个或2个肺叶,部位以尖后段或背段为主,形态表现主要为斑片、斑点、结节影,空洞为厚壁。抗结核药物治疗1个月、2个月、6个月后病灶吸收显效率分别为11.4%、41.3%、65.9%;空洞闭合率分别为8.0%、12.0%、44.0%。结论:菌阴肺结核临床表现不典型或无症状,无特异性相关检查结果,诊断困难;病灶位于活动性结核好发部位,提示肺结核可能;抗结核药物治疗后动态观察病灶吸收及空洞闭合情况对诊断有较大的帮助。展开更多
文摘Background Early detection of pulmonary tuberculosis （PTB） is a big challenge in smear negative and sputum scarce patients in China.Simultaneous amplification and testing methods for detection of the Mycobactedum tuberculosis （MTB） complex （SAT-TB assay） is a novel molecular technique established in our hospital.This method has a high sensitivity and specificity in the lab.In this study,the clinical diagnostic performance of this method in smear-negative or sputum-scarce PTB suspects was investigated and evaluated.Methods Two hundred smear negative and 80 sputum-scarce patients were recruited in this study.Samples that included sputum or bronchial washing fluid were collected and sent for both bacteria culture and SAT-TB assay.Diagnosis for these patients was based on the comprehensive evaluation of chestX-ray/CT study,histology examination,lab results,and treatment response.Sensitivity,specificity,positive predictive value （PPV） and negative predictive value （NPV） for each diagnostic test were investigated and calculated using confirmed tuberculosis （TB） and non-TB cases.The time required for detection of MTB was also measured for each method.Results Ninety-two patients （33％） were diagnosed as definitive TB,112 patients （40％） were probable PTB,and 76 （27％） were non-TB.The sensitivity,specificity,PPV,and NPV of SAT-TB in smear-negative PTB suspects were 93％ （95％ CI,84％-98％）,98％ （95％ CI,90％-100％）,98％ （95％ Cl,91％-100％）,and 93％ （95％ CI,83％-98％）.In sputum scarce PTB suspects,the sensitivity,specificity,PPV,and NPV of the SAT-TB assay on bronchial washing fiuids were 90％ （95％Cl,74％-98％）,100％ （95％ Cl,85％-100％）,100％ （95％ Cl,88％-100％）,and 88％ （95％ CI,69％-97％）.The accuracy of the SAT-TB assay is consistent with the bacteria culture assay.The median time required for detecting MTB in the SAT-TB assay was 0.5 day,which was much faster than bacteria culture （28 days）.Conclusions The SA
基金This work was supported by Grants from the National Natural Sciences Foundation of China(81271893)the Natural Science Foundation of Zhejiang Province(LY12H19002)+2 种基金Zhejiang Provincial Program for the Cultivation of High-level Innovative Health Talents,the Scientific Research Foundation of the Education Department of Zhejiang Province(Y201534356)the Natural Science Foundation of Zhejiang Medical College(2014B01)Visiting Engineer Program of the Education Department of Zhejiang Province(FG2014011).
文摘Background:Quick diagnosis of smear-negative pulmonary tuberculosis(TB)and extra-pulmonary TB are urgently needed in clinical diagnosis.Our research aims to investigate the usefulness of the interferon-γrelease assay(IGRA)for the diagnosis of smear-negative pulmonary and extra-pulmonary TB.Methods:We performed TB antibody and TB-IGRA tests on 389 pulmonary TB patients(including 120 smear-positive pulmonary TB patients and 269 smear-negative pulmonary TB patients),113 extra-pulmonary TB patients,81 patients with other pulmonary diseases and 100 healthy controls.Blood samples for the TB-Ab test and the TB-IGRA were collected,processed,and interpreted according to the manufacturer’s protocol.Results:The detection ratio of smear-positive pulmonary TB patients and smear-negative pulmonary TB patients were 90.8%(109 of 120)and 89.6%(241 of 269),respectively.There was no statistically significant difference of its performance between these two sample sets(P>0.05).The detection ratio of positive TB patients and extra-pulmonary TB patients were 90.0%(350 of 389)and 87.6%(99 of 113),respectively,which was not significantly different(P>0.05).Conclusions:In this work,the total detection ratio using TB-IGRA was 89.4%,therefore TB-IGRA has diagnostic values in smear-negative pulmonary TB and extra-pulmonary TB diagnosis.
文摘Background The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography （CT） and clinical findings in predicting smear- negative pulmonary tuberculosis in AIDS patients. Methods A total of 121 AIDS patients suspected of smear-negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 （47.1%） patients. The CT and clinical predictors were selected to diagnose AIDS-related pulmonary tuberculosis through univariate and multivariate Logistic analysis. Results Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, Iobular consolidation, tree-in-bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut-off point in the diagnosis of AIDS-related smear-negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively. Conclusion The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear-negative pulmonary tuberculosis in AIDS patients.
文摘目的通过对比分析常规剂量和低剂量MSCT扫描对涂阴活动性肺结核CT征象的检出与显示,探讨低剂量MSCT扫描对涂阴活动性肺结核的诊断价值。方法选择我院2009年1月～2012年12月诊治的涂阴活动性肺结核48例,同时进行常规剂量180 m As和低剂量30 m As MSCT扫描,对比分析两种扫描方法对肺结核基本CT征象的检出率、细节显示及扫描剂量等相关资料。结果两种扫描方案对涂阴活动性肺结核基本CT征象检出率、细节显示无显著性差异。低剂量扫描的平均X线辐射剂量为（0.94±0.04）m Sv,明显低于常规扫描的（6.24±0.26）m Sv（P〈0.05）。结论低剂量与常规剂量MSCT扫描对肺结核基本CT征象的检出及显示具有相同价值,辐射剂量大幅降低,适用于涂阴活动性肺结核诊断和鉴别诊断。
文摘Background： Direct ZN （Ziehl-Neelsen） sputum smear microscopy for diagnosis of TB （tuberculosis） has low sensitivity, especially in TB/HIV co-infected patients. Sputum concentration by bleach （NaOCI） with sedimentation has been used to increase the sensitivity of sputum smear microscopy in many settings but with varying results. Objective： To determine whether bleach plus centrifugation significantly improves the detection of AFB （acid-fast bacilli） in ZN smear-negative sputum specimens. Methods： Three hundred and seventy sputum specimens were collected from new TB suspects attending a Nairobi referral district hospital and processed for direct microscopy using ZN technique and culture on Lowenstein Jensen Media. All smear-negative specimens were treated with 3.5% bleach and left to stand for 30 min before centrifugation. The bleach treated smears were processed and examined using ZN technique. Results： Of the 370 specimens, 200 （54%） were positive culture. The number of sputum samples that were smear-positive by direct ZN was 138 （37.2%）, with a sensitivity of 66%. After treatment of direct ZN smear-negative specimens with 3.5% bleach and centrifugation, the total number of AFB smear-positive samples increased to 171 with an increase in sensitivity of 66% to 81.1% （15.1%）. Conclusion： In this study, bleach with centrifugation significantly increased the yield of sputum smear microscopy. Further evaluation of these techniques in routine programmes is required especially in settings where the burden of TB/HIV is high.
文摘目的:探讨菌阴肺结核的临床诊断与治疗,为菌阴肺结核的控制工作提供临床依据。方法:回顾分析126例菌阴肺结核患者的临床资料,分析其临床表现、实验室相关检查及肺CT表现。结果:126例患者的症状和体征无特异性。126例患者中,结核分枝杆菌纯蛋白衍化物(purified protein derivative of tuberculin.PPD)试验(++)68例,(+++)30例,(-)26例,(+)2例;结核抗体试验(immunochroma-tographic test,ICT)阳性39例;腺苷脱氨酶升高45例,血沉升高47例,C-反应蛋白升高20例;肺CT检查显示,病灶累及1个或2个肺叶,部位以尖后段或背段为主,形态表现主要为斑片、斑点、结节影,空洞为厚壁。抗结核药物治疗1个月、2个月、6个月后病灶吸收显效率分别为11.4%、41.3%、65.9%;空洞闭合率分别为8.0%、12.0%、44.0%。结论:菌阴肺结核临床表现不典型或无症状,无特异性相关检查结果,诊断困难;病灶位于活动性结核好发部位,提示肺结核可能;抗结核药物治疗后动态观察病灶吸收及空洞闭合情况对诊断有较大的帮助。
