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Comparison of Histological, Microbiological, and Molecular Methods in Diagnosis of Patients with tbLN Having Different anti-tb treatment Background

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Biomedical and Environmental Sciences 2017年第6期30卷 418-425页

作者： 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 Thoracic Surgery The affiliated hospital of Inner Mongolia Medical University Hohhot 010110 Inner Mongolia China Clinical Center Beijing Tuberculosis & Thoracic Tumor Research Institute Beijing Chest Hospital Capital Medical University Beo'ing 101149 China Department of Thoracic Surgery Beijing Tuberculosis & Thoracic Tumor Research Institute Beijing Chest Hospital Capital Medical University Beijing 101149 China

Objective 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. Methods In this study, suspected patients with tbLN and having different anti-T8 treatment background were enrolled. All the samples were tested simultaneously by histology, ZiehI-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. Results 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-T8 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）. Conclusion Other tests as welt as culture should be considered for patients with tbLN having retreatment history or over 1-month treatment to avoid false negative results.

关键词： Tuberculous lymphadenitis Mycobacterial culture Molecular test anti-tb treatment Drugresistance

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