探讨改良抗酸染色法在结核性胸膜炎诊断中的应用价值

目的 建立改良抗酸染色法,并与离心涂片法和GENEN Xpert相比较,探讨改良抗酸染色法在结核性胸膜炎诊断中的应用价值。方法 应用改良抗酸染色法、离心涂片法、GENEN Xpert同时对84份临床诊断为结核性胸膜炎的胸腔积液标本进行检测,其中,胸腔积液多核细胞>50%的15例（多核为主组）,多核细胞<50%的69例（单核为主组）。结果 84例胸腔积液改良抗酸染色法、离心涂片法、GENEN Xpert的阳性率分别为29.8%（25/84）、7.1%（6/84）、32.1%（27/84）。15例多核为主组改良抗酸染色法、离心涂片法、GENEN Xpert的阳性率分别为80.0%（12/15）、26.7%（4/15）、86.7%（13/15）,69例单核为主组改良抗酸染色法、离心涂片法、GENEN Xpert的阳性率分别为18.8%（13/69）、2.9%（2/69）、20.2%（14/69）,改良抗酸染色法与GENEN Xpert阳性率均高,比较差异无统计学意义（χ²=0.111,P>0.05）, 改良抗酸染色法阳性率明显高于离心涂片法,比较差异有统计学意义（χ²=14.28,P<0.05)。结论 改良抗酸染色法、离心涂片法、GENEN Xpert三种方法中,综合来说改良抗酸染色法诊断结核性胸膜炎阳性率高,经济、快速、简便,敏感性、特异性高,值得临床推广应用。

Diagnostic value of improved Ziehl-Neelsen staining in tuberculous pleurisy

Objective We aimed to establish an improved acid-fast staining method and compare it with the centrifugal smear method and GENEN Xpert to explore the application value of the improved acid-fast staining method in the diagnosis of tuberculous pleurisy. Methods Eighty-four hydrothorax samples from patients that clinically diagnosed as tuberculous pleurisy were examined by improved Ziehl-Neelsen stain, centrifugation smear and Genen Xpert. Among them, 15 cases with polynuclear cell more than 50% in hydrothorax (polynuclear group), and 69 cases with polynuclear cell lower than 50% (mononuclear group). Results The total positive rates of improved Ziehl-Neelsen staining, centrifugation smear and Genen Xpert were 29.8% (25/84), 7.1% (6/84) and 32.1% (27/84), respectively. The positive rates for polynuclear group were 80.0% (12/15), 26.7% (4/15) and 86.7% (13/15), respectively. And the positive rates for mononuclear group were 18.8% (13/69), 2.9% (2/69) and 20.2% (14/69), respectively. There was no significant difference between the positive rate of improved Ziehl-Neelsen stain method and that of GENE Xpert method (χ²=0.111,P>0.05). The positive rate of improved Ziehl-Neelsen stain was higher than that of Centrifugation smear (χ²=14.28,P<0.05). Conclusion Among the three methods of modified acid-fast staining method, centrifugation smear and GENEN Xpert, the improved Ziehl-Neelsen stain method has high positive rate in the diagnosis of tuberculous pleurisy. It is economical and rapid, and worthy of clinical application.