| Backgroud and purposeTuberculosis(TB) is a chronic infectious disease caused by the invasion of mycobacteria TB into the body under certain conditions,especially in young people.The latent period is 4 to 8 weeks. 80 percent of tubercle bacilli invade the lung, called the pulmonary TB; other parts(cervical lymph nodes, meninges, peritonea, bowel, skin, bones, etc.) may suffer a secondary infection. Droplet transmission is the most important route of TB, and the source of infection is mainly the secondary pulmonary tuberculosis patients. Except for very few urgent cases, it is shown clinically a chronic process, with systemic symptoms such as low fever, fatigue and respiratory system performance like coughing, or even hemoptysis. As the polution of the environment, the increasing of the population and the spreading of HIV/AIDS, the incidence of tuberculosis became more and more intense. Nowadays about one third of the world's population(about 2 million) have been infected by mycobacterium TB, including almost half of the population in our country. Every year almost 130 thousand people died of TB. According to the result of the fifth national TB epidemic sampling survey report, in China, the infection rate is on the rise, with low detection rate, however. About two thirds of the patients are active ones, but three fifth of mycobacterium TB smear-positive patients have not been discovered. Based on this, timely diagnosis is one of the significant means to control the spreading of TB.To diagnose TB, doctors mainly adopt the analysis of imaging examination, pathological examination, laboratory examination and tuberculin purified protein derivative(TB-PPD) experiment, in addition to combination with clinical symptoms and medical history data. The methods of diagnosing TB through laboratory tests include microbial examination methods, examination of molecular biology and immunology examination. The microbial examination method, used commonly for clinic, is berculosis bacterium smear, acid-fast stain and mycobacterium culture. Molecular biology examination is mycobacterium TB fluorogenic quantitative detection. Immunology examination is combined with three specific immune cells to detect specific T lymphocytes and mycobacterium TB(Tspot-TB) detection. In this paper, by the comparison of the acid fast stain, tuberculosis bacterium cultivation, TB- PCR, Mycodot three test and Tspot-TB, the five common clinical laboratory methods of diagnosing TB, we will explore the clinical diagnostic significance of combining Tspot-TB and Mycodot three test experiments to the bacterium negative TB patients. Research objects and grouping277 cases of suspected TB patients selected from in-hospital patients in pneumology department in Thoracic Hospital in Henan province from November 2015 to July 2016, 150 cases of which are male and 127 cases female, aged between 18 and 76, 29±2 in average.Personal information collected from the 277 patients(including age, gender, duration, history of allergies, medication history, etc.), acid-fast stain, TB bacterium cultivation, TB-PCR, and Tspot-TB of the detected patients.In combination with the related imaging examination and clinical follow-up, 277 patients are divided into 3 groups as follows.Group A is the positive TB group, with 97cases(male 46, female 51). Patients had typical clinical symptoms. The diagnosis in accordance with international infectious tuberculosis diagnostic criteria. This group of experiment is used to assess the sensitivity of the methods.Group B is the TB bacterium negative group, with 93 cases(male 49, female 44). The patients have been excluded to suffer non-TB lung diseases, and conforms to the diagnosis standard of bacterium negative TB given by "tuberculosis diagnosis and treatment guidelines" set by TB branch of Chinese medical association in 2001. According to the patients' medical history, we have reduced the effects of anti-tuberculosis treatment on the experimental results. In this Group we will compare the related experiment to assess the diagnostic significance of the joint experiment.Group C is a non-TB group, with 87 cases(male 55, female 32). We have excluded the existence of TB through the relevant examinations, and have confirmed 31 cases of lobar pneumonia, 16 cases of chronic obstructive pneumonia, 23 cases of small cell lung cancer and 17 cases of lung abscess. This group is used to evaluate the specificity of the various methods. Statistical processingWe employ the software SPSS17.0 for the statistical analysis and present the data by the mean value plus or minus the standard deviation.The sample mean between two groups is computed by X2 test. Setting ?=0.05,P<0.05 for the difference as statistical significance. Results1, Among the acid-fast stain, TB bacterium culture, TB-PCR, TB antibody tests and Tspot-TB test, Tspot-TB test has the highest sensitivity.2,Tspot-TBcombined with TB antibody tests,the positive rate of positive dection rate was significantly increased on the negative tuberculosis. The comparison between only Tspot-TB or TB antibody tests indicates statistical significance.3, The comparison between conjoined Tspot-TB and TB antibody tests with single experiment indicates no significant statistical significanceon the non-TB group.4, The diagnostic index of the conjoined test of TB antibody tests and Tspot-TB test is 190.9%,higher than the single experiment with TB antibody tests and Tspot-TB. The difference is statistically significant.ConclusionFor TB diagnosis of bacterium negativeness, the conjointed test of TB antibody tests and Tspot-TB test can improve the detection rate. |
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