Objective:To understand the application of microscopic scanners in detecting the false positive and negative results of acid-fast bacilli in clinical smear samples, to optimize the instrument detection parameters, and to continuously improve the detection accuracy.Methods:The data from Guangzhou Chest Hospital were studied from December 2019 to June 2020. For the clinical samples from sputum, bronchoscopy flushing fluid, pleural effusion, cerebrospinal fluid, and joint effusion, direct smears were performed on their glass slides provided with the instrument as required. The dried smears were stained for auramine O fluorescence. Manual retest was performed on all the instrument-reported positive smears, and about 15% of the instrument-reported negative smears were randomly selected. The false positive and negative rates were described as categorical data. For those with false negative results, the position of the manually retested acid-fast bacilli in the smear was marked with a microscope slide clip coordinate ruler, and the locations inside and outside the scanning area of the instrument were estimated.Results:Among the 5 284 smears, 1 290 cases were reported positive by the instrument, and 850 cases were reported positive by manual retest, with a false positive rate of 34.11% (440/1 290). Six hundred and sixty-five negative smear samples reported by the instrument were randomly checked, and 100 cases were reported positive by manual retest, with a false negative rate of 15.04%. The false negative results included 38 cases ±, 50 cases 1+, 6 cases 2+, 4 cases 3+, and 2 cases 4+. Among the false-negative smears, 42 cases of acid-fast bacteria were found in the scanning area of the instrument, and 58 cases outside the area. The false negative rates of the two were 6.32% (42/665) and 8.72% (58/665), respectively.Conclusion:The detection of acid-fast bacilli in clinical samples by microscopic scanners has certain false positive and negative rates. The instrument scanning parameters should be continuously improved, and the laboratory manual retest procedures should be strengthened.

Objective:To explore the transmission of tuberculosis caused by treatment delay, cavitation, lesion range, bacterial load, and other factors in school contacts with pathogen positive cases of pulmonary tuberculosis.Methods:The clinical diagnosis and treatment data of 79 patients with pathogen-positive pulmonary tuberculosis from the universities and middle schools at Yuexiu District, Guangzhou, including 45 males and 24 females who were 12-25 years old and hereinafter referred to as "clue cases", were retrospectively analyzed. And the results of tuberculin skin test (TST) of their 4 934 contacts at their campuses or schoolyard, including 1 867 males and 3 067 females who were 12-65 years old, were analyzed.Results:The clue cases came from 33 universities and middle schools. Thirteen patients with tuberculosis were found in the close contacts of 12 clue cases at 8 universities and middle schools, hereinafter referred to as "contact cases"; 7 clue cases and 2 contact cases presented treatment delay of 7-81 days and 16-76 days, respectively. There were no statistical differences in delay of seeking medical attention, diagnosis delay, cavitation, lesion range, and pathogenic testing (including smears and cultures) between the healthy and sick cases of the contacts. The positive rate and strong positive rate of TST were 68.36% (1 934/2 829) and 21.81% (617/2 829) in the clue cases' close contacts, and were 47.84% (1 007/2 105) and 3.42% (72/2 105) in the clue cases' non-close contacts ( P＜0.001). Conclusion:It is essential that screening of close contacts should be strengthened in school tuberculosis control for the early detection of tuberculosis cases.

Objective:To explore the clinical application values of tuberculin skin test (TST) and interferon-γ release assays (IGRAs) in the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous.Methods:The data of IGRAs (T-SPOT.TB method) and TST test results of 603 patients with pulmonary tuberculosis [343 males and 260 females; the age of the bacteria positive group was (52±20) years old, and that of the bacteria negative group was (48±20) years old] and 242 patients with pulmonary diseases other than tuberculous [116 males and 126 females, with the age of (40±16) years old] who came to our hospital from January 2018 to December 2019 were collected. And the clinical significance of IGRAs, TST alone, and their 8 combined test models results were analyzed with the diagnostic test evaluation method.Results:In the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous, the sensitivities of TST and IGRAs were 96.85% (584/603) and 88.89% (536/603), and the specificity were 7.85% (19/242) and 83.06% (201/242), respectively. In terms of positive test results, among 13 test models, which included 5 independent tests [TST (1+) above, TST (2+) above, TST (3+) above, TST (4+), and IGRAs (+)], 4 types of parallel tests [TST (1+) above/IGRAs (+), TST (2+) above/IGRAs (+), TST (3+) above/IGRAs (+), and TST (4+)/IGRAs (+)],and 4 types of serial tests [TST (1+) above + IGRAs (+), TST (2+) above + IGRAs (+), TST (3+) above + IGRAs (+), and TST (4+) + IGRAs (+)], IGRAs (+) test model presented the best diagnostic performance, and its diagnostic sensitivity, specificity, accuracy, odds ratio ( OR), positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 88.89% (536/603), 83.06% (201/242), 87.22% (737/845), 39.22, 92.89% (536/577), 75.00% (201/268), 5.25, and 0.13, respectively. Conclusion:As a latent tuberculosis infection test, IGRAs have good auxiliary diagnostic values in the differential diagnosis of pulmonary tuberculosis and pulmonary diseases other than tuberculous.

<正>中国防痨协会在1995年制定并于2006年再版修订但至今仍作为实验室常规操作标准的《结核病诊断细菌学检验规程》(简称"规程")[1],体现了实验室的细菌学检查对结核病诊断和流行病学预防的重要性。在规程中,国际公认的55种分枝杆菌中有致病性的36种分枝杆菌的生物化学要点被罗列了出来,其中把对硝基苯甲酸(PNB)作为区别Mtb与非结核分枝杆菌(NTM)的惟一实验标准,为实验室进行分枝杆菌分型鉴定制定了一套较为完善的鉴定程序。但在实验室的日常常规工作中笔者却发现规程存有值得商榷之处。

<正>分枝杆菌菌型鉴定在结核病流行病学调研和临床用药指导方面起到了至关重要的作用,因由Mtb或非结核分枝杆菌(non-tuberculosis Mycobacteria,NTM)引致的肺部疾病,其临床症状和X线影像表现没有任何的区别,但临床治疗有很大的差异甚至完全不同,因此结核分枝杆菌复合群(MTC)与NTM正确的区分尤为重要。故中国防痨协会基础专业委员会在1995年制定并于2006年再版修订了《结核

目的:了解和分析丙酮酸钠培养基与改良罗氏培养基对分枝杆菌培养阳性率的影响,为实验室提高分枝杆菌培养阳性率提供科学依据。方法:714份临床送检标本按常规进行有关前处理后同时接种于丙酮酸钠培养基与改良罗氏培养基,前两周每3天观察1次,以后每周观察1次,并记录出现阳性的时间,8周后未见生长者记录为阴性结果。结果:丙酮酸钠培养基与改良罗氏培养基总阳性率分别是24.09%和22.97%,两者比较差异无统计学意义。其中复治组病例阳性率分别是23.76%和19.80%,两者差异有显著性意义;出现阳性平均天数分别是25.33、31.29天。结论:丙酮酸钠培养基能提高分枝杆菌尤其是复治病例的培养阳性率,而且能比改良罗氏培养基平均提前6天得出阳性结果。

目的对医院内不同实验室或同一实验室不同生化检测系统检测结果进行比对分析和偏差评估,实现医院内不同生化检测系统检测结果一致性。方法参考美国临床实验室标准化委员会(NC-CLS)的EP15-A文件,以Roch Modular P800检测系统(S)为目标检测系统,Roch COBAS 400检测系统(1、2)、CL8000检测系统(3)为实验检测系统,检测患者血清TBIL、ALT、AST含量,进行比对研究和统计学分析,计算偏倚(SE%),实验检测系统比对项目取偏倚最高者与1/4CLIA'88允许误差进行比较,偏倚(SE%)小于等于1/4CLIA'88允许总误差(TBIL、ALT、AST1/4CLIA'88允许总误差均为5%),达到该项目院内检测结果一致性目的。结果①用原校准品校准各检测系统进行比对分析,TBIL、ALT、AST偏倚(SE%)分别为5.6%、19.2%、5.3%②采用目标检测系统定值的新鲜患者混合血清作为临时校准物校准各实验检测系统,第一次比对结果TBIL、ALT、AST偏倚(SE%)分别为5.3%、7.5%、4.7%;第二次比对结果TBIL、ALT、AST偏倚(SE%)分别为4.0%、4.1%、3.6%,实验检测系统比对项目SE%均小于5%,检测结果达院内一致性要求。结论采用目标检测系统定值的患者新鲜混合血清作为临时校准物,校准各实验检测系统的比对分析是实现医院内不同生化检测系统检测结果一致性的有效途径。

目的观察和评价化疗联用母牛分支杆菌菌苗(vaccae)在菌阳肺结核治疗的临床疗效。方法采用随机对照分组法将300例患者分为母牛分支杆菌治疗观察组、对照组。每组初、复治涂阳各60例,耐多药30例。结果观察组痰菌阴转、病变吸收方面明显优于对照组,初治涂阳患者疗效末痰菌阴转率:观察组100%,对照组91.7%。两组结果无显著差异性(P>0.05)。复治涂阳组疗程末痰菌阴转率95%,对照组75%。两组结果有显著性差异(P<0.01)。耐多药患者疗程末痰菌阴转率观察组56.7%,对照组26.7%,两组结果有显著性差异(P<0.01)。初、复治菌阳二月末,耐多药三月末观察组及对照组均有显著差异(0.01<P<0.05)。耐多药结核患者血清T淋巴细胞亚群测定显示,在疗程末,CD4明显升高,CD8下降,经统计学处理,差异有显著性(P<0.01)。结论母牛分支菌菌苗在菌阳肺结核治疗中,能协同增加化疗疗效。有助于痰菌阴性、病灶吸收好转、空洞缩小,可作为菌阳肺结核的免疫治疗和化疗的辅助治疗。