肺泡灌洗液噬菌体裂解法检测肺结核诊断价值研究
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摘要
目的:探讨肺泡灌洗液(BALF)噬菌体裂解法(PhaB)快速检测结核分枝杆菌的临床应用价值。
方法:30例肺结核患者及30例非肺结核患者(其中肺癌12例、肺炎5例、慢性阻塞性疾病13例)肺泡灌洗液标本进行噬菌体裂解法实验,并与其他肺结核检查方法(痰涂片抗酸染色、痰罗氏培养法、肺泡灌洗液涂片抗酸染色、肺泡灌洗液罗氏培养法、PPD、TB-AB)对照。
结果:30例肺结核患者肺泡灌洗液噬菌体裂解法阳性18例,阴性12例;肺泡灌洗液抗酸染色法阳性9例,阴性21例;肺泡灌洗液结核菌培养法阳性20例,阴性10例;痰涂片抗酸染色法阳性6例,阴性24例;痰结核菌培养法阳性11例,阴性19例。30例非肺结核患者PPD试验及结核抗体(TB-AB)检测假阳性例数分别为10例及7例,而肺泡灌洗液噬菌体裂解法、肺泡灌洗液涂片抗酸染色、肺泡灌洗液罗氏培养法、痰抗酸染色及培养法假阳性例数均为0例;肺泡灌洗液噬菌体裂解法敏感性60.0%,与痰抗酸染色、痰罗氏培养法、肺泡灌洗液涂片抗酸染色相比较,差异有显著意义(三者均P<0.05);与肺泡灌洗液罗氏培养法相比较,差异无显著意义(P>0.05);其特异性为100%,高于PPD试验及结核抗体检测;此法阳性预测值为100%,阴性预测值为96.8%。
结论:肺泡灌洗液噬菌体裂解法检测结核分枝杆菌快速、简便,可作为结核病诊断的重要方法。
0bjective:To explore the value of phage–based splitting assay(PhaB) in fast dectection of mycobacterium tuberculosis (MTB) in bronchoalverolar lavage fluid (BALF).
Methods : The BALF from 30 pulmonary tuberculosis patients and 30 non-tuberculosis patients (including the lung cancer 12 cases、pneumonia 5 cases、chronic obstructive pulmonary disease 13 cases) were dectected by phage–based splitting assay, and the test results were compared with that of other examinatinos (BALF acid-fast stain, BALF culture, acid-fast stain, sputum culture,BCG-ppd 5IU skin test and Blood TB-Ab).
Results:Amony 30 pulmonary tuberculosis patients,18 cases were positive by BALF PhaB, and 12 cases were negative;9 cases were positive by BALF acid-fast stain , and 21 cases were negative;20 cases were positive by BALF culture , and 10 cases were negative;6 cases were positive by sputum acid-fast stain , and 24 cases were negative;11 cases were positive by sputum culture , and 19 cases were negative。Amony 30 non-tuberculosis patients ,10 cases were positive by PPD, 7 cases were positive by TB-AB,none was positive by BALF PhaB, BALF acid-fast stain, BALF culture, acid-fast stain and sputum culture.The sensitivity of phage–based splitting assay was 60.0%, compared with that of sputum acid-fast stain, sputum culture and BALF acid-fast stain, there extisted high significative meaning(P<0.05). Compared with that of BALF culture, it has not significative meaning(P>0.05).The specificity was 100%, and it was significantly higher than that of BCG-ppd 5IU skin test or Blood TB-Ab.The postive and negative predicitive rate were 100%, 96.8% respectively.
Conclusion:BALF- Phage–based splitting assay is a fast conventient method for dectecting MTB in BALF, and it can be used as an important dignostic method for TB.
方法:30例肺结核患者及30例非肺结核患者(其中肺癌12例、肺炎5例、慢性阻塞性疾病13例)肺泡灌洗液标本进行噬菌体裂解法实验,并与其他肺结核检查方法(痰涂片抗酸染色、痰罗氏培养法、肺泡灌洗液涂片抗酸染色、肺泡灌洗液罗氏培养法、PPD、TB-AB)对照。
结果:30例肺结核患者肺泡灌洗液噬菌体裂解法阳性18例,阴性12例;肺泡灌洗液抗酸染色法阳性9例,阴性21例;肺泡灌洗液结核菌培养法阳性20例,阴性10例;痰涂片抗酸染色法阳性6例,阴性24例;痰结核菌培养法阳性11例,阴性19例。30例非肺结核患者PPD试验及结核抗体(TB-AB)检测假阳性例数分别为10例及7例,而肺泡灌洗液噬菌体裂解法、肺泡灌洗液涂片抗酸染色、肺泡灌洗液罗氏培养法、痰抗酸染色及培养法假阳性例数均为0例;肺泡灌洗液噬菌体裂解法敏感性60.0%,与痰抗酸染色、痰罗氏培养法、肺泡灌洗液涂片抗酸染色相比较,差异有显著意义(三者均P<0.05);与肺泡灌洗液罗氏培养法相比较,差异无显著意义(P>0.05);其特异性为100%,高于PPD试验及结核抗体检测;此法阳性预测值为100%,阴性预测值为96.8%。
结论:肺泡灌洗液噬菌体裂解法检测结核分枝杆菌快速、简便,可作为结核病诊断的重要方法。
0bjective:To explore the value of phage–based splitting assay(PhaB) in fast dectection of mycobacterium tuberculosis (MTB) in bronchoalverolar lavage fluid (BALF).
Methods : The BALF from 30 pulmonary tuberculosis patients and 30 non-tuberculosis patients (including the lung cancer 12 cases、pneumonia 5 cases、chronic obstructive pulmonary disease 13 cases) were dectected by phage–based splitting assay, and the test results were compared with that of other examinatinos (BALF acid-fast stain, BALF culture, acid-fast stain, sputum culture,BCG-ppd 5IU skin test and Blood TB-Ab).
Results:Amony 30 pulmonary tuberculosis patients,18 cases were positive by BALF PhaB, and 12 cases were negative;9 cases were positive by BALF acid-fast stain , and 21 cases were negative;20 cases were positive by BALF culture , and 10 cases were negative;6 cases were positive by sputum acid-fast stain , and 24 cases were negative;11 cases were positive by sputum culture , and 19 cases were negative。Amony 30 non-tuberculosis patients ,10 cases were positive by PPD, 7 cases were positive by TB-AB,none was positive by BALF PhaB, BALF acid-fast stain, BALF culture, acid-fast stain and sputum culture.The sensitivity of phage–based splitting assay was 60.0%, compared with that of sputum acid-fast stain, sputum culture and BALF acid-fast stain, there extisted high significative meaning(P<0.05). Compared with that of BALF culture, it has not significative meaning(P>0.05).The specificity was 100%, and it was significantly higher than that of BCG-ppd 5IU skin test or Blood TB-Ab.The postive and negative predicitive rate were 100%, 96.8% respectively.
Conclusion:BALF- Phage–based splitting assay is a fast conventient method for dectecting MTB in BALF, and it can be used as an important dignostic method for TB.
引文
[1] World Health Organization. Groups at Risk : WHO Report on the Tuberculosis Epidemic. World Health Organization ,Geneva , Switzerland. 1996.
[2]何权瀛.充分发挥综合性医院在肺结核防治工作中的作用.中华结核和呼吸杂志,2005,28: 143-144
[3]何国钧,肖和平,新世纪肺结核诊断与鉴别诊断的重要性.中华结核和呼吸杂志,2004,7: 385-386
[4] Wilson SM , Suwaidi Z , McNerney R , et al . Evaluation of a new rapid bacteriophage based method for the drug susceptibility testing of Mycobacterium tuberculosis. Nat Med , 1997 ,3 (4) :465-468.
[5]黄海荣,马屿.噬菌体在结核分枝杆菌研究中的应用.中华结核和呼吸杂志, 2002, 25 (8) : 497 - 499.
[6]吴雪琼.我国结核病实验室诊断研究的主要进展[J] .中华结核和呼吸杂志,2003 ,26(8) :477.
[7] Schatteman KA , Goossens FJ , Leurs J , et al . Fast homogeneous assay for plasma procarboxypeptidase [J ] . Clin Chem Lab Med , 2001 , 39 (9) : 806-810.
[8] Sarkar SK,Sharm GS ,Gupta HR ,et al. Fibroptic bronchoscopy in the diagnosis of pulmonary tuberculosis [ J ] . Tuberclc , 1980 , 61 : 97.
[9]王安潮,吴彬.纤支镜检查在可疑肺结核诊断中的应用价值[J] .中华结核和呼吸杂志,1993 ,16 :265.
[10] Marei AM, Behedy EM.Mohtady HA,et al.Afify,Evaluation of a rapid bacteriophage based method for the detection of Mycobacterium tuberculosis in clinical samples.J Med Microbiol,2003,52(pt 4):331-335.
[11] Wren BW, Stabler RA , Das SS , et al . Characterization of a haemolysin from mycobacterium tuberculosis with homology to a virulence factor of serpulina hyodysenteriae [ J ] . Microbiology , 1998 ,144 :1205 - 1211.
[12] TI AU , Willemse JL , Leurs J R , Hendriks DF: Fast kinetic assay for t he determination of procarboxypeptid-ase U ( TAFI) in human plasma.[J ] . J Thromb Haemost , 2005 , 3 (10) : 2353-2355.
[13]尹本义,曾育青.纤维支气管镜灌洗致病性播散.中国防痨杂志,1991 ,13 (3) :116.
[14] Eltringham I J ,Drobniewski F A ,ManganJ A. Evaluation of reverse transcription-PCR and a bacteriophage-based assay for rapid phenol-typic detection of rifampin resistance in clinical isolates of Mycobacterium tuberculosis [J ] . Clin Microbiol 1999 ,37 :3524～3527.
[15] Eltringham IJ ,Wilson SM , Drobniewski FA. Evaluation of a bacteriophage-based assay (phage amplified biologically assay) as a rapid screen for resistance to isoniazid, ethambutol, strep to mycin, pyrazinamide, and cip rofloxacin among clinicaliso lates of mycobacteriumtuberculosil[J ]. J Clin Microbio l, 1999, 37 (11) : 3528-3532.
[16] McNerney RP , Kiepiela KS , Bishop PM, et al . Rapid screening of Mycobacterium tuberculosis for susceptibility to rifampicin and streptomycin. Int J Tuberc Lung Dis , 2000 ,4 :127.
[17]胡忠义.结核分枝杆菌耐药性快速测定方法及其评价[J ] .中华结核和呼吸杂志,2003 ,26(2) :107 - 109.
[18] Alcaide F , Gali N , Dominguez J , et al . Usefulness of a new Mycobacterio phage-based technique for rapid diagnosis of pulmonary tuberculosis. J Clin Microbiol , 2003 , 41 : 2867-2871.
[19] Takiff H , Heifets L. In search of rapid diagnosis and drug-resistance detection tools : is the FASTPlaqueTB test the answer ? Int J Tuberc Lung Dis , 2002 ,6 : 560-561.
[20]彭丽,陈保文,罗永艾,等.利用噬菌体杀灭巨噬细胞内耻垢分枝杆菌的实验研究[J ] .中华结核和呼吸杂志, 2005 ,28 (9) : 619-2622
[21]吕斌,徐顺清,符志军等.利用重组分枝杆菌噬菌体快速筛选耐利福平结核分枝杆菌[ J ].中华结核和呼吸杂志, 2000, 23(6): 480-483
[1] Edgar R, McKinst ry M, Hwang J, et al. High-sensitivity bacterial detection using biotintagged phage and quantumdot nanocomplexes[J ]. Proc Natl Acad Sci USA , 2006, 103 (13) : 4841-4845.
[2] Albert H , Trollip A , Seaman T , et al . Simple , phage-based( FASTPplaque) technology to determine rifampicin resistance of Mycobacterium tuberculosis directly f rom sputum[J ] . Int J Tuberc Lung Dis , 2004 , 8 (9) : 1114-1119.
[3] Simboli N , Takiff H , McNerney R , et al . Inhouse phage amplification assay is a sound alternative for detecting rifampin-resistant Mycobacterium tuberculosis in low resource settings[J ] . Antimicrob Agent s Chemot her , 2005 , 49 (1) : 425-427.
[4] Wilson SM , Suwaidi Z , McNerney R , et al . Evaluation of a new rapid bacteriophage -based method for the drug susceptibility testing of Mycobacterium tuberculosis. Nat Med , 1997 ,3 (4) :465-468.
[5]胡忠义,庞茂银,靳安佳,等.应用噬菌体裂解法快速鉴定结核分枝杆菌[J ] .中华结核和呼吸杂志,2001 ,24(10) :611.
[6]胡忠义.结核分枝杆菌耐药性快速测定方法及其评价[J ] .中华结核和呼吸杂志,2003 ,26(2) :107 - 109.
[7] Ayman MM ,Eman ME , Heba AM ,et al . Evaluation of a rapid bacteriophage-based method for the detection of Mycobacterium tuberculosis inclinical samples. J Med Microb- iol ,2003 ,52 (pt 4) : 331-335.
[8]吕斌,徐顺清,符志军,等.利用重组分支杆菌噬菌体快速筛选耐利福平结核分支杆菌.中华结核和呼吸杂志, 2000, 23: 480 - 484.
[9] McNerney R. TB :the return of the phage. A review of fifty years of mycobacter phage[J ] . Int J Tuberc Lung Dis ,1999 ,3(3) :179.
[10]吴雪琼.我国结核病实验室诊断研究的主要进展[J].中华结核和呼吸杂志,2003 ,26(8) :477.
[11] Phulpoto MA ,Qayyum S ,Rizvi N ,et al . Diagnostic yield of fast plaque TB test for rapid detection of Mycobacterium in tuberculosis suspect s. J Pak Med Assoc ,2005 ,55 (2) :57-60.
[12] Butt T , Ahmad RN , Kazmi SY, et al . Rapid diagnosis of pulmonary tuberculosis by mycobacteriophage assay. Int J Tuberc Lung Dis ,2004 ,8 (7) :899-902.
[13] GalíN , Domínguez J , Blanco S , et al . Utility of an in2house mycobacteriophage-based assay for rapid detection of rifampin resistance in mycobacterium tuberculosis clinical isolates. J ClinMicrobiol ,2003 ,41 (6) :2647-2649.
[14] McNerney R , Wilson SM , Sidhu AM , et al . Inactivation of mycobacteriophage D29 using ferrous ammonium sulphate as a tool for t he detection of viable Mycobacterium smegmatis and M. tuberculosis. Res Microbiol ,1998 ,149 (7) :487-495.
[15] Eltringham I J ,Drobniewski F A ,ManganJ A. Evaluation of reverse transcription-PCR and abacteriophage-based assay for rapid phenoltypic detection of rifampin resistance in clinical isolates of Mycobacterium tuberculosis [J ] . Clin Microbiol 1999 ,37 :3524～3527.
[16] Eltringham IJ ,Wilson SM , Drobniewski FA. Evaluation of a bacteriophage-based assay (phage amplified biologically assay) as a rapid screen for resistance to isoniazid, ethambutol, strep to mycin, pyrazinamide, and cip rofloxacin among clinicaliso lates of mycobacterium tuberculosil[J ]. J Clin Microbio l, 1999, 37 (11) : 3528-3532.
[17] McNerney RP , Kiepiela KS , Bishop PM, et al . Rapid screening of Mycobacterium tuberculosis for susceptibility to rifampicin and streptomycin. Int J Tuberc Lung Dis , 2000 ,4 :127.
[18]庞茂银,胡忠义,王奕峰,等.噬菌体裂解法与BAC-TECT460法在结核分枝杆菌快速检测中的比较[J ].中华传染病杂志, 2003, 21 (1) : 27-29.
[19]黄国盛,林健雄,赵立文,等.噬菌体裂解法与BAC-TECT460法检测结核分枝杆菌的应用比较[J ].河北医学, 2004, 8 (10) : 750-752.
[20] McNerney R , Bupe SK, J uliana K, et al . Development of a bacteriophage phage replication assay for diagnosis of pulmonary tuberculosis. J Med Microbiol ,2004 ,42 (5) :2115-2120.
[21] Alcaide F , Gali N , Dominguez J , et al . Usefulness of a new Mycobacterio phage-based technique for rapid diagnosis of pulmonary tuberculosis. J Clin Microbiol , 2003 , 41 : 2867-2871.
[22]Takiff H , Heifets L. In search of rapid diagnosis and drug-resistance detection tools : is the FASTPlaqueTB test the answer ? Int J Tuberc Lung Dis , 2002 ,6 : 560-561.
[2]何权瀛.充分发挥综合性医院在肺结核防治工作中的作用.中华结核和呼吸杂志,2005,28: 143-144
[3]何国钧,肖和平,新世纪肺结核诊断与鉴别诊断的重要性.中华结核和呼吸杂志,2004,7: 385-386
[4] Wilson SM , Suwaidi Z , McNerney R , et al . Evaluation of a new rapid bacteriophage based method for the drug susceptibility testing of Mycobacterium tuberculosis. Nat Med , 1997 ,3 (4) :465-468.
[5]黄海荣,马屿.噬菌体在结核分枝杆菌研究中的应用.中华结核和呼吸杂志, 2002, 25 (8) : 497 - 499.
[6]吴雪琼.我国结核病实验室诊断研究的主要进展[J] .中华结核和呼吸杂志,2003 ,26(8) :477.
[7] Schatteman KA , Goossens FJ , Leurs J , et al . Fast homogeneous assay for plasma procarboxypeptidase [J ] . Clin Chem Lab Med , 2001 , 39 (9) : 806-810.
[8] Sarkar SK,Sharm GS ,Gupta HR ,et al. Fibroptic bronchoscopy in the diagnosis of pulmonary tuberculosis [ J ] . Tuberclc , 1980 , 61 : 97.
[9]王安潮,吴彬.纤支镜检查在可疑肺结核诊断中的应用价值[J] .中华结核和呼吸杂志,1993 ,16 :265.
[10] Marei AM, Behedy EM.Mohtady HA,et al.Afify,Evaluation of a rapid bacteriophage based method for the detection of Mycobacterium tuberculosis in clinical samples.J Med Microbiol,2003,52(pt 4):331-335.
[11] Wren BW, Stabler RA , Das SS , et al . Characterization of a haemolysin from mycobacterium tuberculosis with homology to a virulence factor of serpulina hyodysenteriae [ J ] . Microbiology , 1998 ,144 :1205 - 1211.
[12] TI AU , Willemse JL , Leurs J R , Hendriks DF: Fast kinetic assay for t he determination of procarboxypeptid-ase U ( TAFI) in human plasma.[J ] . J Thromb Haemost , 2005 , 3 (10) : 2353-2355.
[13]尹本义,曾育青.纤维支气管镜灌洗致病性播散.中国防痨杂志,1991 ,13 (3) :116.
[14] Eltringham I J ,Drobniewski F A ,ManganJ A. Evaluation of reverse transcription-PCR and a bacteriophage-based assay for rapid phenol-typic detection of rifampin resistance in clinical isolates of Mycobacterium tuberculosis [J ] . Clin Microbiol 1999 ,37 :3524～3527.
[15] Eltringham IJ ,Wilson SM , Drobniewski FA. Evaluation of a bacteriophage-based assay (phage amplified biologically assay) as a rapid screen for resistance to isoniazid, ethambutol, strep to mycin, pyrazinamide, and cip rofloxacin among clinicaliso lates of mycobacteriumtuberculosil[J ]. J Clin Microbio l, 1999, 37 (11) : 3528-3532.
[16] McNerney RP , Kiepiela KS , Bishop PM, et al . Rapid screening of Mycobacterium tuberculosis for susceptibility to rifampicin and streptomycin. Int J Tuberc Lung Dis , 2000 ,4 :127.
[17]胡忠义.结核分枝杆菌耐药性快速测定方法及其评价[J ] .中华结核和呼吸杂志,2003 ,26(2) :107 - 109.
[18] Alcaide F , Gali N , Dominguez J , et al . Usefulness of a new Mycobacterio phage-based technique for rapid diagnosis of pulmonary tuberculosis. J Clin Microbiol , 2003 , 41 : 2867-2871.
[19] Takiff H , Heifets L. In search of rapid diagnosis and drug-resistance detection tools : is the FASTPlaqueTB test the answer ? Int J Tuberc Lung Dis , 2002 ,6 : 560-561.
[20]彭丽,陈保文,罗永艾,等.利用噬菌体杀灭巨噬细胞内耻垢分枝杆菌的实验研究[J ] .中华结核和呼吸杂志, 2005 ,28 (9) : 619-2622
[21]吕斌,徐顺清,符志军等.利用重组分枝杆菌噬菌体快速筛选耐利福平结核分枝杆菌[ J ].中华结核和呼吸杂志, 2000, 23(6): 480-483
[1] Edgar R, McKinst ry M, Hwang J, et al. High-sensitivity bacterial detection using biotintagged phage and quantumdot nanocomplexes[J ]. Proc Natl Acad Sci USA , 2006, 103 (13) : 4841-4845.
[2] Albert H , Trollip A , Seaman T , et al . Simple , phage-based( FASTPplaque) technology to determine rifampicin resistance of Mycobacterium tuberculosis directly f rom sputum[J ] . Int J Tuberc Lung Dis , 2004 , 8 (9) : 1114-1119.
[3] Simboli N , Takiff H , McNerney R , et al . Inhouse phage amplification assay is a sound alternative for detecting rifampin-resistant Mycobacterium tuberculosis in low resource settings[J ] . Antimicrob Agent s Chemot her , 2005 , 49 (1) : 425-427.
[4] Wilson SM , Suwaidi Z , McNerney R , et al . Evaluation of a new rapid bacteriophage -based method for the drug susceptibility testing of Mycobacterium tuberculosis. Nat Med , 1997 ,3 (4) :465-468.
[5]胡忠义,庞茂银,靳安佳,等.应用噬菌体裂解法快速鉴定结核分枝杆菌[J ] .中华结核和呼吸杂志,2001 ,24(10) :611.
[6]胡忠义.结核分枝杆菌耐药性快速测定方法及其评价[J ] .中华结核和呼吸杂志,2003 ,26(2) :107 - 109.
[7] Ayman MM ,Eman ME , Heba AM ,et al . Evaluation of a rapid bacteriophage-based method for the detection of Mycobacterium tuberculosis inclinical samples. J Med Microb- iol ,2003 ,52 (pt 4) : 331-335.
[8]吕斌,徐顺清,符志军,等.利用重组分支杆菌噬菌体快速筛选耐利福平结核分支杆菌.中华结核和呼吸杂志, 2000, 23: 480 - 484.
[9] McNerney R. TB :the return of the phage. A review of fifty years of mycobacter phage[J ] . Int J Tuberc Lung Dis ,1999 ,3(3) :179.
[10]吴雪琼.我国结核病实验室诊断研究的主要进展[J].中华结核和呼吸杂志,2003 ,26(8) :477.
[11] Phulpoto MA ,Qayyum S ,Rizvi N ,et al . Diagnostic yield of fast plaque TB test for rapid detection of Mycobacterium in tuberculosis suspect s. J Pak Med Assoc ,2005 ,55 (2) :57-60.
[12] Butt T , Ahmad RN , Kazmi SY, et al . Rapid diagnosis of pulmonary tuberculosis by mycobacteriophage assay. Int J Tuberc Lung Dis ,2004 ,8 (7) :899-902.
[13] GalíN , Domínguez J , Blanco S , et al . Utility of an in2house mycobacteriophage-based assay for rapid detection of rifampin resistance in mycobacterium tuberculosis clinical isolates. J ClinMicrobiol ,2003 ,41 (6) :2647-2649.
[14] McNerney R , Wilson SM , Sidhu AM , et al . Inactivation of mycobacteriophage D29 using ferrous ammonium sulphate as a tool for t he detection of viable Mycobacterium smegmatis and M. tuberculosis. Res Microbiol ,1998 ,149 (7) :487-495.
[15] Eltringham I J ,Drobniewski F A ,ManganJ A. Evaluation of reverse transcription-PCR and abacteriophage-based assay for rapid phenoltypic detection of rifampin resistance in clinical isolates of Mycobacterium tuberculosis [J ] . Clin Microbiol 1999 ,37 :3524～3527.
[16] Eltringham IJ ,Wilson SM , Drobniewski FA. Evaluation of a bacteriophage-based assay (phage amplified biologically assay) as a rapid screen for resistance to isoniazid, ethambutol, strep to mycin, pyrazinamide, and cip rofloxacin among clinicaliso lates of mycobacterium tuberculosil[J ]. J Clin Microbio l, 1999, 37 (11) : 3528-3532.
[17] McNerney RP , Kiepiela KS , Bishop PM, et al . Rapid screening of Mycobacterium tuberculosis for susceptibility to rifampicin and streptomycin. Int J Tuberc Lung Dis , 2000 ,4 :127.
[18]庞茂银,胡忠义,王奕峰,等.噬菌体裂解法与BAC-TECT460法在结核分枝杆菌快速检测中的比较[J ].中华传染病杂志, 2003, 21 (1) : 27-29.
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