全自动显微扫描系统与人工镜检检测痰标本中抗酸杆菌的效果比较

李静; 戴碗琴; 郁晨蕾; 袁锋; 王莉莉; 沈鑫; 江渊

doi:10.19428/j.cnki.sjpm.2023.22357

全自动显微扫描系统与人工镜检检测痰标本中抗酸杆菌的效果比较

Comparison between the Mycob.T scanner system and manual microscopy in detecting acid-fast bacilli in sputum specimens

摘要

摘要:
目的比较全自动显微扫描系统与人工镜检检测痰标本中抗酸杆菌的效果。
方法选择上海市5家结核病定点医院作为研究现场，连续纳入2020年1—11月肺科门诊初诊的疑似肺结核患者1 519例，对收集到的每例疑似肺结核患者痰标本分别进行痰涂片和BACTEC MGIT 960液体培养（简称“液体培养”）检查。痰涂片检查采用直接涂片法制作2张痰涂片，1张采用传统萋-尼氏抗酸染色人工镜检，另1张采用自动染片机萋-尼氏抗酸染色全自动显微扫描系统进行扫描。以液体培养结果为标准，比较人工镜检和全自动显微扫描系统检测痰标本中抗酸杆菌的效能。分析全自动显微扫描系统重复性扫描结果和人工镜检复核结果。
结果全自动显微扫描系统阳性检出率为14.4%（219/1 519），人工镜检阳性检出率为16.3%（248/1 519），两者差异无统计学意义（χ²=2.13，P=0.145）。以液体培养结果为标准，人工镜检检测痰标本中抗酸杆菌的灵敏度60.36%（236/391）高于全自动显微扫描系统52.94%（207/391），差异有统计学意义（χ²=4.38，P=0.036）；2种方法检测特异度（98.94%）均较高；人工镜检和全自动显微扫描系统检查结果一致率为95.46%，Kappa值为0.826。全自动显微扫描系统重复性测试和人工镜检复核结果显示，全自动显微扫描系统重复性测试符合率为99.5%（436/438），人工镜检复检符合率为98.6%（432/438）。
结论全自动显微扫描系统检测痰标本中抗酸杆菌特异度高，与人工镜检检测结果一致性好；相比人工镜检，全自动显微扫描系统可大大缓解人工镜检的工作强度。

Abstract:
Objective To compare the efficacy between the Mycob.T scanner system and manual microscopy for detecting acid-fast bacilli in sputum specimens.
Methods Between January and November 2020， a total of 1 519 sputum samples from suspected primary tuberculosis patients from 5 designated tuberculosis hospitals in Shanghai were examined by Smear and BACTEC MGIT 960 liquid culture （liquid culture） methods. Each specimen was subiected to 2 direct smear slides. One slide was stained by Z-N method and examined with manual microscopic method. Another slide was stained and scanned by the Mycob.T system. The efficacy of manual microscopy and the Mycob.T scanner system for detecting acid-fast bacilli in sputum specimens was compared based on the result of liquid culture. Results of the repetitive scanning by the Mycob.T scanner system and the recheck of the manual microscopy were analyzed.
Results The average positive rate by the Mycob.T scanner system was 14.4% （219/1 519） while the average positive rate by manual microscopy was 16.3% （248/1 519）. No significant difference was observed （χ²=2.13， P=0.145）. Based on liquid culture confirmation results， the sensitivity of manual microscopy （60.36%） was higher than that of the Mycob.T scanner system （52.94%）， and the difference is statistically significant （χ²=4.38， P=0.036）. Both methods had high specificity （98.94%）. The concordance of the Mycob.T scanner system and manual microscopy was 95.46%， with the kappa value of 0.826. The results of repeatability test of the Mycob.T scanner system and the recheck results of the manual microscopy showed that the coincidence rate of scanning by the Mycob.T scanner system was 99.5% （436/438）， and the recheck coincidence rate by the manual microscopy was 98.6% （432/438）.
Conclusion The Mycob.T scanner system have high specificity for detecting acid-fast bacilli in sputum samples and good consistency with the results of manual microscopy. Compared with manual microscopic examination， the Mycob.T scanner system can greatly alleviate the work intensity.

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