不同检测方法快速诊断结核性胸膜炎临床评价
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摘要
目的探讨几种检测方法对结核性胸膜炎的诊断价值,以寻找更好的结核性胸膜炎快速诊断方法。方法选取50例渗出性胸腔积液未确诊患者,进行经胸腔镜壁层胸膜活检。对胸腔积液和胸膜活检样本进行细菌培养、聚合酶链反应(PCR)、病理组织学等显微镜检查(直接和细胞离心后)。对分离自胸腔积液的单核细胞进行T细胞斑点试验。结果胸膜活检样本结核分枝杆菌阳性率高于胸腔积液样本。胸腔积液和胸膜活检样本经细胞离心处理后,敏感性分别提高到20.0%和37.5%。T细胞斑点试验敏感性(98.6%)和特异性(95.6%)较好。结论胸膜活检样本的微生物学检查与病理组织学检查相结合是诊断结核性胸膜炎的最佳方法;胸膜活检样本的微生物学检查比胸腔积液样本有更高的阳性率;T细胞斑点试验作为辅助诊断结核性胸膜炎的方法值得在临床推广。
Objective To investigate the roles of different methods for the rapid diagnosis of tuberculous pleurisy,and to find a method for rapid diagnosis. Methods A total of 50 patients with undiagnosed exudative pleural effusion were enrolled. Using thoracoscopy,the biopsy specimens of parietal pleura were taken under direct vision. Pleural effusion and biopsy specimens were subjected to bacterial culturing,polymerase chain reaction(PCR),histopathological microscopic examination(directly and after cytocentrifugation). Mononuclear cells were isolated from pleural effusion and determined by T cell spot test. Results The biopsy specimens proved to have a higher determination rate of Mycobacterium tuberculosis than pleural effusion. Cytocentrifugation improved the sensitivity of microscopic examination for pleural effusion increasing by 20.0% and biopsy specimens increasing by37.5%. T cell spot test had higher sensitivity(98.6%) and speci?city(95.6%). Conclusions The combination of microbiological examination and histopathological examination of biopsy specimens is the best method for the diagnosis of tuberculous pleurisy,and microbiological examination using biopsy specimens has a higher determination rate than using pleural effusion. T cell spot test is worth the clinical application for the diagnosis of tuberculous pleurisy.
Objective To investigate the roles of different methods for the rapid diagnosis of tuberculous pleurisy,and to find a method for rapid diagnosis. Methods A total of 50 patients with undiagnosed exudative pleural effusion were enrolled. Using thoracoscopy,the biopsy specimens of parietal pleura were taken under direct vision. Pleural effusion and biopsy specimens were subjected to bacterial culturing,polymerase chain reaction(PCR),histopathological microscopic examination(directly and after cytocentrifugation). Mononuclear cells were isolated from pleural effusion and determined by T cell spot test. Results The biopsy specimens proved to have a higher determination rate of Mycobacterium tuberculosis than pleural effusion. Cytocentrifugation improved the sensitivity of microscopic examination for pleural effusion increasing by 20.0% and biopsy specimens increasing by37.5%. T cell spot test had higher sensitivity(98.6%) and speci?city(95.6%). Conclusions The combination of microbiological examination and histopathological examination of biopsy specimens is the best method for the diagnosis of tuberculous pleurisy,and microbiological examination using biopsy specimens has a higher determination rate than using pleural effusion. T cell spot test is worth the clinical application for the diagnosis of tuberculous pleurisy.
引文
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[16]刁小莉,金木兰,曹勍,等.结核性胸膜炎经胸腔镜胸膜活检诊断66例临床病理分析[J].诊断病理学杂志,2016,23(5):349-352.
[17]陈敏,陈捷,宋大伟.三种检测技术联用在结核性胸膜炎诊断中的应用价值[J].中国防痨杂志,2016,38(8):634-638.
[18]TERRA R M,ANTONANGELO L,MARIANI A W,et al.Pleural fluid adenosine deaminase(ADA)predicts survival in patients with malignant pleural effusion[J].Lung,2016,194(4):681-686.
[2]ZANTAH M,DATTA D.Tuberculous pleural effusion occurring concurrently with asbestos-related pleural disease[J].Respir Med Case Rep,2017,21:135-137.
[3]GUNLUOGLU G,OLCMEN A,GUNLUOGLU M Z,et al.Long-term outcome of patients with undiagnosed pleural effusion[J].Arch Bronconeumol,2015,51(12):632-636.
[4]DIXIT R,AQARWAL K C,GOKHROO A,et al.Diagnosis and management options in malignant pleural effusions[J].Lung India,2017,34(2):160-166.
[5]PORCEL J M,LUI M M,LERNER A D,et al.Comparing approaches to the management of malignant pleural effusions[J].Expert Rev Respir Med,2017,11(4):273-284.
[6]LEWINSOHN D M,LEONARD M K,LOBUE PA,et al.Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines:diagnosis of tuberculosis in adults and children[J].Clin Infect Dis,2017,64(2):111-115.
[7]AGARWAL A,PRASAD R,GARQ R,et al.Medical thoracoscopy:a useful diagnostic tool for undiagnosed pleural effusion[J].Indian J Chest Dis Allied Sci,2014,56(4):217-220.
[8]GAO B A,ZHOU G,GUAN L,et al.Effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudative pleural effusion of unknown etiology:a retrospective study of 215 patients[J].J Thorac Dis,2014,6(5):438-443.
[9]SAHN S A,HUGGINS J T,SAN JOSéM E,et al,Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone?[J].Int J Tuberc Lung Dis,2013,17(6):787-793.
[10]KIM C H,LEE S Y,LEE Y D,et al.Atypical pleural fluid profiles in tuberculous pleural effusion:sequential changes compared with parapneumonic and malignant pleural effusions[J].Intern Med,2016,55(13):1713-1719.
[11]郑立恒,柳晓金,刘会,等.3种方法在诊断结核性胸膜炎中的价值[J].河北医科大学学报,2016,37(7):822-825.
[12]SUN Q,XIAO H P,SHA W.A scoring model for a differential diagnosis of tuberculous and non-tuberculous pleurisy[J].Zhonghua Yi Xue Za Zhi,2011,91(34):2392-2396.
[13]PEREZ-VELEZ C M,ROYA-PABON C L,MARAISB J.A systematic approach to diagnosing intra-thoracic tuberculosis in children[J].J Infect,2017,74(Suppl1):S74-S83.
[14]YANG L,HU Y J,LI F G,et al.Analysis of cytokine levers in pleural effusions of tuberculous pleurisy and tuberculous empyema[J].Mediators Inflamm,2016,2016:3068103.
[15]BISWAS B,SHARMA S K,NEGI R S,et al.Pleural effusion:role of pleural fluid cytology,adenosine deaminase level,and pleural biopsy in diagnosis[J].JCytol,2016,33(3):159-162.
[16]刁小莉,金木兰,曹勍,等.结核性胸膜炎经胸腔镜胸膜活检诊断66例临床病理分析[J].诊断病理学杂志,2016,23(5):349-352.
[17]陈敏,陈捷,宋大伟.三种检测技术联用在结核性胸膜炎诊断中的应用价值[J].中国防痨杂志,2016,38(8):634-638.
[18]TERRA R M,ANTONANGELO L,MARIANI A W,et al.Pleural fluid adenosine deaminase(ADA)predicts survival in patients with malignant pleural effusion[J].Lung,2016,194(4):681-686.