Che Nan Ying, Huang Shao Jun, Ma Yan, Han Yi, Liu Zi Chen, Zhang Chen, Mu Jing, Zhao Dan, Qu Yang, Zhang Hai Qing, Liu Zhi Dong, Xu Shao Fa
Department of Pathology, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.
Department of Pathology, Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China; Department of Thoracic Surgery, The affiliated hospital of Inner Mongolia Medical University, Hohhot 010110, Inner Mongolia, China.
Biomed Environ Sci. 2017 Jun;30(6):418-425. doi: 10.3967/bes2017.055.
The influence of anti-tuberculosis (TB) treatment history on tuberculous lymphadenitis (TBLN) diagnosis is unclear. Therefore, this study aims to evaluate the diagnostic methods, including histology, microbiology, and molecular tests, used for TBLN.
In this study, suspected patients with TBLN and having different anti-TB treatment background were enrolled. All the samples were tested simultaneously by histology, Ziehl-Neelsen (ZN) staining, mycobacterial culture (culture), Xpert MTB/RIF (xpert), real-time PCR, and high-resolution melting curve PCR (HRM). Thereafter, the performance of these methods on samples with different anti-TB treatment background was assessed.
In our study, 89 patients were prospectively included 82 patients with TBLN and 7 with other diseases. The overall sensitivities of Xpert, real-time PCR, histology, ZN staining, and culture were 86.6%, 69.5%, 58.5%, 43.9%, and 22.0%, respectively. The anti-TB treatment history revealed dramatic influences on the sensitivity of culture (P < 0.0001). In fact, the treatment that lasted over 3 months also influenced the sensitivity of Xpert (P < 0.05). However, the treatment history did not affect the performance of remaining tests (P > 0.05). For rifampicin drug susceptibility test (DST), the anti-TB treatment showed only significant influence on the success rate of culture DST (P = 0.001), but not on those of Xpert and HRM tests (P > 0.05).
Other tests as well as culture should be considered for patients with TBLN having retreatment history or over 1-month treatment to avoid false negative results.
抗结核治疗史对结核性淋巴结炎（TBLN）诊断的影响尚不清楚。因此，本研究旨在评估用于TBLN的诊断方法，包括组织学、微生物学和分子检测。
本研究纳入了具有不同抗结核治疗背景的疑似TBLN患者。所有样本同时进行组织学、萋-尼（ZN）染色、分枝杆菌培养（培养）、Xpert MTB/RIF（Xpert）、实时荧光定量PCR和高分辨率熔解曲线PCR（HRM）检测。此后，评估这些方法在不同抗结核治疗背景样本上的性能。
在我们的研究中，前瞻性纳入了89例患者，其中82例为TBLN患者，7例为其他疾病患者。Xpert、实时荧光定量PCR、组织学、ZN染色和培养的总体敏感性分别为86.6%、69.5%、58.5%、43.9%和22.0%。抗结核治疗史对培养的敏感性有显著影响（P<0.0001）。事实上，持续超过3个月的治疗也影响了Xpert的敏感性（P<0.05）。然而，治疗史并未影响其余检测的性能（P>0.05）。对于利福平药物敏感性试验（DST），抗结核治疗仅对培养DST的成功率有显著影响（P=0.001），但对Xpert和HRM检测的成功率无影响（P>0.05）。
对于有复治史或治疗超过1个月的TBLN患者，应考虑采用培养以外的其他检测方法，以避免假阴性结果。
