吴淑红 荣福 欧阳雁弟

【摘要】 目的 探討荧光定量聚合酶链反应（PCR）检测支气管肺泡灌洗液（BALF）结核分枝杆菌脱氧核糖核酸（TbDNA）诊断肺结核的临床价值。方法 选取51例肺结核患者作为肺结核组， 另选60例非肺结核患者作为对照组。所有患者均完善BALF TbDNA检测及毛刷涂片抗酸染色镜检、痰涂片抗酸染色镜检。以评价BALF中TbDNA检测对诊断肺结核的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）。结果 荧光定量PCR检测BALF中的TbDNA， 其阳性对肺结核诊断的敏感性、特异性、PPV、NPV分别为74.51%、96.67%、95.00%、81.69%， 肺结核组毛刷涂片抗酸染色镜检的敏感性为13.73%， 痰涂片抗酸染色镜检敏感性为15.69%。对照组中， 荧光定量PCR检测BALF中的TbDNA的特异性为96.67%， 毛刷涂片抗酸染色镜检及痰涂片抗酸染色镜检的特异性均为100.00%。肺结核组荧光定量PCR检测BALF中的TbDNA与痰涂片抗酸染色镜检及毛刷涂片抗酸染色镜检敏感性比较差异有统计学意义（P<0.05）。对照组荧光定量PCR检测BALF中的TbDNA与毛刷涂片抗酸染色镜检及痰涂片抗酸染色镜检的特异性比较差异无统计学意义（P>0.05）。结论 荧光定量PCR检测BALF中的TbDNA有良好的特异性和敏感性， 有望辅助传统的检查来早期诊断肺结核。

【关键词】 荧光定量聚合酶链反应；支气管肺泡灌洗液；结核分枝杆菌脱氧核糖核酸；肺结核

DOI：10.14163/j.cnki.11-5547/r.2018.10.007

【Abstract】 Objective To disucss the clinical value of fluorescence quantitative polymerase chain reaction （PCR） in detection of mycobacterium tuberculosis deoxyribonucleic acid （TbDNA） in bronchoalveolar lavage fluid （BALF） for the diagnosis of pulmonary tuberculosis. Methods There were 51 pulmonary tuberculosis patients as pulmonary tuberculosis group， and 60 non-pulmonary tuberculosis patients as control group. All patients improved BALF TbDNA detection， brush smear acid-fast staining， sputum smear acid-fast staining， so as to evaluate the sensitivity， specificity， positive predictive value （PPV） and negative predictive value （NPV） of TbDNA detection in BALF for diagnosis of tuberculosis. Results TbDNA in BALF was detected by fluorescence quantitative PCR， and the sensitivity， specificity， PPV and NPV of the positive pulmonary tuberculosis were 74.51%， 96.67%， 95% and 81.69% respectively. In the pulmonary tuberculosis group， the sensitivity of brush smear acid-fast staining was 13.73%， and the sensitivity of sputum smear acid-fast staining was 15.69%. In the control group， the specificity of fluorescence quantitative PCR for detection of TbDNA in BALF was 96.67%. The specificity of brush smear acid-fast staining and sputum smear acid-fast staining were 100.00%. In the pulmonary tuberculosis group， there was statistically significant difference in sensitivity of TbDNA in BALF detected by fluorescence quantitative PCR， comparing with sputum smear acid-fast staining and brush smear acid-fast staining （P<0.05）. In the control group， there was no statistically significant difference in specificity of TbDNA in BALF detected by fluorescence quantitative PCR， comparing with brush smear acid-fast staining and sputum smear acid-fast staining （P>0.05）. Conclusion Fluorescence quantitative PCR shows good specificity and sensitivity in detection of TbDNA in BALF， and it is expected to assist traditional examination in the early diagnosis of pulmonary tuberculosis.

【Key words】Fluorescence quantitative polymerase chain reaction； Bronchalveolar lavage fluid； Tuberculosis deoxyribonucleic acid； Pulmonary tuberculosis

结核病是一个全球性的卫生问题， 据世界卫生组织统计， 其仍然是全世界的首要传染病杀手， 2013年全球有900万人患结核病， 其中死亡150万人， 且近年来在世界范围内出现流行， 呈增长的趋势[1]。控制结核病的关键在于早发现， 早隔离和治疗活动性肺结核[2]。结核病可累及全身多脏器， 但以肺结核最为常见。目前肺结核的病原学检查方法主要包括培养和涂片， 但培养费时， 涂片阳性率低， 且肺结核的临床症状多不典型， 且缺乏特征性的影像学表现， 因此， 部分肺结核患者无法得到早期诊断， 甚至出现漏诊和误诊。……