目的 探讨如何提高超声引导下穿刺活检对肺外结核（extrapulmonary tuberculosis，EPTB）的诊断价值。方法 对152例临床疑诊结核或诊断不明病灶的患者进行超声引导下穿刺活检，综合分析组织切片加特殊染色（病理组）、基因X-Pert MTB/RIF检测（基因组）、结核菌培养（菌培组）及涂片这4种方法的诊断效能。结果 明确诊断结核108例，临床最终诊断结核112例。4种检查方法检测结核的阳性率（检出率）分别为：病理组诊断率70.4%（88/125），可疑诊断率5.6%（7/125）；基因组71.2%（74/104）；菌培组43.7%（45/103）；涂片组46.4%（52/112）。联合诊断检出率达96.4%（108/112）。本组无假阳性。结论 超声引导下穿刺活检对EPTB的诊断安全、简便、有效，联合基因及相关实验室检查能提高诊断率，病理及基因X-Pert MTB/RIF检测的诊断效能明显高于菌培及涂片。
Abstract
Objective To explore how to improve the diagnostic value of ultrasound-guided biopsy for extrapulmonary tuberculosis (EPTB). Methods A total of 152 patients with clinically suspected EPTB or unknown diagnosis underwent ultrasound-guided needle biopsy.The diagnostic efficacy of 4 methods including tissue section with special staining,gene X-Pert MTB/RIF detection,tuberculosis culture and smear was comprehensively analyzed. Results one hundred and eight cases were definitely diagnosed with tuberculosis,and finally 112 cases were diagnosed clinically.The positive rate (detection rate) of diagnosis in each group were as follows:70.4% (88/125) in pathological group with the suspicious diagnosis rate of 5.6% (7/125);71.2% (74/104) in gene X-Pert MTB/RIF group;43.7% (45/103) in culture group;46.4% (52/112) in smear group.There was no false positive case in this study. Conclusion Ultrasonal-guided biopsy is safe,convenient and effective in the diagnosis of EPTB.Combined with relevant laboratory tests,the diagnostic rate can be improved.The diagnostic efficacy of pathology and gene X-Pert MTB/RIF examination is significantly higher than that of culture and smear examinations.
关键词
结核病 /
肺外结核(EPTB) /
超声 /
活检 /
诊断
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Key words
tuberculosis /
extrapulmonary tuberculosis (EPTB) /
ultrasound /
biopsy /
diagnosis
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中图分类号：
R521
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参考文献
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脚注
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基金
上海市科委科研计划项目（18411970800）
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