摘要：
Objective To evaluate the value of fluorescent quantitative-PCR (FQ-PCR) detecting TB-DNA and TB culture of bronchoalveolar lavage fluid (BALF) in clinical diagnosis of tuberculosis. Methods A total of 587 patients who were initially diagnosed were collected from April to December in 2016 in Nanjing Chest Hospital, in which 525 cases were the tuberculosis group and the other 62 cases were the non-tuberculosis group. FQ-PCR and TB culture were performed in all patients. Results 1. The positive rate of FQ-PCR was higher than that of TB cul-ture (41.40% vs. 31.86%) (P<0.01). 2. The sensitivity,specificity,PPV,NPV and accuracy of FQ-PCR were 46.1%,98.39%,99.59%,17.73% and 51.62% respectively, and those in TB culture method were 35.62%, 100%,100%,15.50% and 42.42% respectively. 3. When the two methods were joint detected, the sensitivity, specificity,PPV,NPV and accuracy all increased to 52.19%,98.39%,99.64%,19.55% and 57.07% respec-tively. Conclusion Both FQ-PCR detecting TB-DNA and TB culture of BALF have a good application value in clini-cal diagnosis of tuberculosis. The combined detection of these two methods is more efficient than TB-DNA or TB cul-ture alone in clinical diagnosis of tuberculosis.%目的 评价支气管肺泡灌洗液(BALF)荧光定量聚合酶链反应(FQ-PCR)检测TB-DNA与TB培养两种方法在肺结核诊断中的临床价值.方法 回顾分析南京市胸科医院2016年4月到12月收治的587例初次住院患者标本,其中肺结核组525例,非肺结核组62例,收集所有患者的BALF标本,同时做TB-DNA (FQ-PCR法)检测和TB培养,比较两方法的阳性率差异和性能指标.结果 (1) BALF的TB-DNA(FQ-PCR法)和TB培养的阳性率分别为41.40%和31.86%,两种方法阳性率比较差异有统计学意义(P<0.01).(2)两种方法在肺结核诊断中的灵敏度分别为46.1%和35.62%,特异度分别为98.39%和100%,阳性预测值分别为99.59%和100%,阴性预测值分别为17.73%和15.50%、诊断效率分别为51.62%和42.42%.(3)两种方法联合检测在肺结核诊断中的灵敏度为52.19%,特异度为98.39%,阳性预测值为99.64%,阴性预测值为19.55%,诊断效率为57.07%.结论 BALF的TB-DNA(FQ-PCR法)和TB培养两方法在肺结核的诊断上均有较好的临床应用价值,BALF的FQ-PCR检测TB-DNA和TB培养联合检测,能更有效的提高肺结核诊断率.
