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.

目的探究结核分枝杆菌RNA恒温扩增实时荧光检测技术（SAT-TB）检测支气管肺泡灌洗液（BALF）对涂阴肺结核的诊断价值。方法对本院涂阴疑似肺结核患者进行筛查,共有80例患者进入最后分析,痰涂片连续3次阴性者进入研究,行培养法（Bactec MGIT 960）及SAT-TB检测,同时进行诊断。分别以培养法（BD960）及以临床诊断作为参考标准,计算SAT-TB法诊断涂阴肺结核的敏感度、特异度、阳性预测值及阴性预测值。结果以培养法（BD960）作为参考标准,SAT-TB诊断涂阴肺结核的敏感度为53.3%（8/15）,特异度为88.2%（15/17）,阳性预测值80.0%（8/10）,阴性预测值68.1%（15/22）。以临床诊断作为参考标准,SAT-TB诊断涂阴肺结核的敏感度31.7%（20/63）、特异度88.2%（15/17）、阳性预测值91.0%（20/22）、阴性预测值25.9%（15/58）。SAT-TB的检测时间约2 h,快于培养法（BD960）的平均阳性报告时间14.1 d。结论 SAT-TB可通过检测BALF为涂阴肺结核患者提供一项敏感度相对于快速培养法（BD960法）较有优势的实验室辅助诊断方法。

目的 探讨PCR熔解曲线法对耐药性测定的临床应用价值.方法 收集广州市胸科医院2016年6月-2016年12月住院200例痰涂片阳性的患者的痰标本,运用PCR熔解曲线法和培养药敏法分别进行检测耐药性,评价两种方法检测的一致性.结果 PCR熔解曲线法在初治患者中,检测异烟肼耐药情况的灵敏度为71.43％,特异度为96.77％,一致性为94.34％;检测利福平耐药情况的灵敏度为80％,特异度为97.92％,一致性为96.23％.在复治患者中,检测异烟肼耐药情况的灵敏度为35％,特异度为81.25％,一致性为55.56％;检测利福平耐药情况的灵敏度为82.35％,特异度为94.74％,一致性为88.89％.结论 PCR熔解曲线法检测方法快速,可用于初治患者利福平、异烟肼耐药性的快速检测和复治患者利福平耐药性的快速检测,可指导临床用药;但对复治患者异烟肼耐药性检测准确度不够.

目的 了解2013-2015年广州市旧城区分枝杆菌的流行情况.方法 选取广州市胸科医院2013年1月至2015年12月门诊和住院患者作为研究对象,共10 743例.研究对象均由结核病实验室收集了痰液、尿液、胸腹腔积液、脑脊液和穿刺液等标本,并经分枝杆菌培养为阳性.采用结核菌群特异性分泌蛋白MPB64免疫胶体金法进行菌群鉴定,对MPB64检测阴性或阳性但怀疑非结核分枝杆菌(non-tuberculosis mycobacteria,NTM)混合生长者,使用基因芯片法进行菌种鉴定,对芯片法无法鉴定者进行基因测序.结果 10 743例研究对象中,有201例鉴定为无分枝杆菌,涂片结果为杂菌生长.共鉴定出8012株MTB(76.00％),2530株NTM(24.00％).NTM种群分布达17种,最常见的是龟-脓肿复合群分枝杆菌、胞内分枝杆菌、鸟分枝杆菌,分别占10.64％(1122/10 542)、6.24％(658/10 542)、3.00％(316/10 542).NTM阳性患者中,男性占49.48％(1133/2290),女性占50.52％(1157/2290),男性、女性感染比例最高的年龄段均为55～64岁,分别占26.30％(298/1133)和25.32％(293/1157).结论 2013-2015年广州市旧城区分枝杆菌感染者中MTB为主要致病菌.NTM感染菌群种类较多,中老年人感染比例较高.

目的 评价PCR-线性杂交酶显色法(以下称“显色法”)与BD960液体法检测结核杆菌对INH及RFP耐多药结核杆菌药敏试验结果的对比分析.方法随机选取疑似结核病患者痰标本680例中得到的涂片阳性标本180例,其中结核分枝杆菌耐药分离株88例(分离株),以BD960液体法为金标准,采用显色法与BD960液体法对INH及RFP耐药性检测,比较两种方法的药敏结果的相符性.结果 分离得到耐药结核杆菌菌株88例,显色法测得单耐INH79株、单耐RFP68株,同时耐INH和RFP61株.BD960液体法测得单耐INH80株、单耐RFP67株,同时耐INH和RFP61株;单耐INH两法测定相符74例,相符率为84.09％(74/88);单耐RFP两法测定相符65例,相符率为73.9％ (65/88) (P ＜0.05),因而两种方法之间差异有统计学意义.结论 显色法与BD960法,两者具有很好的一致性.前者为耐多药患者对INH和RFP药敏检测提供更为快速有效的诊断方法.