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目的对比临床常用的尘肺结核相关实验室检查方法,为提高诊断效率提供科学依据。方法收集某煤炭集团总医院结核病科2013年4月-2015年4月住院治疗的尘肺病例200例。以病原学检查和治疗试验为金标准,将病原学检查阳性或治疗试验阳性的尘肺患者作为病例组(100例);将病原学检查阴性或治疗试验阴性的尘肺患者作为对照组(100例)。对收集的数据进行统计学处理,因素分析采用t检验或χ~2检验,计算各指标的灵敏度、特异度、约登指数、kappa值,采用ROC曲线进行比较。结果 C反应蛋白诊断尘肺结核的效率最佳,其最佳临界值(cutoff值)为6.5mg/L,灵敏度为71%,特异度为85%,约登指数(YI)为0.56,ROC曲线的曲线下面积(AUC)为0.801;γ-干扰素释放试验灵敏度为86%,特异度为53%,YI为0.39,AUC=0.695;ASSURE TB Rapid灵敏度为48%,特异度为89%,YI为0.37,AUC=0.685;24h集菌试验灵敏度为27%,特异度为100%,YI为0.27,AUC=0.635;痰涂片检查灵敏度为24%,特异度为100%,YI为0.24,AUC=0.620;罗氏痰培养与BACTEC快速痰培养相同,灵敏度为19%,特异度为100%,YI为0.19,AUC=0.595;SD Rapid TB灵敏度为20%,特异度为98%,YI为0.18,AUC=0.590;TB-CHECK-1灵敏度为17%,特异度为98%,YI为0.15,AUC=0.575。结论作为结核诊断的金标准,细菌学检查指标特异度均可以达到100%,但其中灵敏度最高的24h集菌试验灵敏度也只有27%。现有诊断方法单独使用时,C反应蛋白的诊断效率明显高于其他方法。对于尘肺结核的确切诊断现有的检查方法,其灵敏度、特异度依然有限,临床仍然迫切需求诊断效率更高的检查方法来对尘肺结核确诊。
Objective To compare clinical laboratory tests of pneumoconiosis and tuberculosis commonly used clinically to provide a scientific basis for improving diagnostic efficiency. Methods A total of 200 cases of pneumoconiosis treated in hospital from April 2013 to April 2015 in a coal group General Hospital were collected. The etiological examination and treatment test as the gold standard, the etiological examination positive or positive test treatment of pneumoconiosis patients as the case group (100 cases); the negative or pathogenic pneumoconiosis test negative control patients as a control group (100 cases) . Statistical analysis was performed on the data collected. The t-test or χ ~ 2 test was used to analyze the sensitivity, specificity, Youden index and kappa value of each index, and the ROC curve was used for comparison. Results C - reactive protein was the most effective method for the diagnosis of pneumoconiosis. The optimal cutoff value was 6.5 mg / L, the sensitivity was 71%, the specificity was 85%, and Yooden ’s index (YI) was 0.56. The ROC curve The area under the curve (AUC) was 0.801; the sensitivity of gamma interferon release assay was 86%, specificity was 53%, YI was 0.39, AUC was 0.695, ASSURE TB Rapid sensitivity was 48% and specificity was 89% 0.37, AUC = 0.685. The sensitivity and specificity of the collected bacteria were 27%, 100%, YI 0.27 and AUC 0.635 respectively. The sensitivity of sputum smear was 24%, specificity was 100%, YI was 0.24, AUC = 0.620; Roche sputum culture and BACTEC rapid sputum culture the same sensitivity of 19%, specificity of 100%, YI 0.19, AUC = 0.595; SD Rapid TB sensitivity of 20%, specificity of 98%, YI 0.18, AUC = 0.590; TB-CHECK-1 17% sensitivity, specificity 98%, YI 0.15, AUC = 0.575. Conclusion As the gold standard for diagnosis of tuberculosis, the specificity of bacteriological examination indexes can all reach 100%, but the sensitivity of the 24-hour germicidal test with the highest sensitivity is only 27%. When used alone, the diagnostic efficiency of C-reactive protein is significantly higher than other methods. For the exact diagnosis of pneumoconiosis tuberculosis existing methods of detection, the sensitivity and specificity is still limited, the clinical still urgently need to diagnose more efficient methods of diagnosis of pneumoconiosis.