| Objectives This article mainly explores the differences of general conditions,clinical manifestations,blood routine examination,imaging manifestations and complications between smear negative and smear positive pulmonary tuberculosis patients,which can better serve the clinic,Taking BD960 liquid fast tubercle bacillus culture as the gold standard,the sensitivity and specificity of three different laboratory methods of sputum smear acid fast staining,sputum Gene Xpert-MTB / RIF and sputum tubercle bacillus culture were compared,and the breakthrough significance of Gene Xpert-MTB / RIF technology in the diagnosis of smear negative pulmonary tuberculosis was analyzed.Methods Through the electronic case system of the hospital,the case data of 400 newly treated pulmonary tuberculosis patients admitted by the tuberculosis Department of our hospital from June 1,2018 to June 1,2019 were checked.After clinical symptoms and signs,imaging manifestations,immunological examination,etiological detection and curative effect observation after anti-tuberculosis treatment,all the patients included in the study met the diagnostic criteria for initial treatment of pulmonary tuberculosis.The 400 patients were divided into group A and group B based on the positive smear(including nocturnal sputum,early morning sputum and daytime secondary phlegm)as the standard,group A(162 patients with smear negative),and group B(238 patients with smear positive example).The general data,clinical symptoms,blood routine indexes,imaging features and complications of the 400 patients were collected and recorded.SPSS22.0 was used to analyze the collected data.Through the differences in the above aspects,the clinical characteristics of smear negative pulmonary tuberculosis were understood.The results of Gene Xpert-MTB/RIF examination and mycobacterium tuberculosis culture in two groups of patients were recorded and statistically analyzed to explore the clinical significance of Gene Xpert-MTB/RIF in the detection of smear-negative pulmonary tuberculosis.Result 1.Comparison of the general situation of the two groups: There were 111 males in group A(smear negative),the ratio of males to females was 2.17:1,the age distribution was between 17-83 years old,the average was(43.5 ± 19.1)years old;there were 174 males in group B(smear positive),the ratio of males to females was 2.72:1,the age distribution was between 13-87 years old,the average was(50.8 ± 19.3)years old.There was no significant difference in gender between the two groups(P > 0.05),but there was significant difference in age(P < 0.05).2.Comparison of clinical manifestations between the two groups:The incidence of fever(71 people)and cough / expectoration(126 people)in group A(smear negative)was 43.8% and 77.8% respectively,while the incidence of fever(133 people)and cough / expectoration(212 people)in group B(smear positive)was 55.9% and 89.1% respectively,the difference was statistically significant(P < 0.05).There was no significant difference in the incidence of night sweat,hemoptysis,anemia and hypoproteinemia between the two groups(P > 0.05).3.Comparison of Blood Routine Indexes between the two groups:The neutrophils in group A(smear negative)were significantly lower than those in group B(smear positive),the difference was statistically significant(P < 0.05).There was no significant difference in the levels of leukocyte,monocyte,lymphocyte,hemoglobin and platelet between the two groups(P > 0.05).4.Comparison of imaging findings between the two groups:Group A(smear negative)patients had caseous pneumonia,bilateral lobes involved or accumulated more than three lobes,and the proportion of cavity formation was significantly lower than group B(smear positive),while the proportion of pulmonary fibrosis and pleurisy was significantly higher than group B(smear positive),the difference between the two groups was statistically significant(P < 0.05).However,in the imaging data,there was no significant difference between the two groups in the major lesion types and lymph node swelling data(P > 0.05).5.Comparison of complications between the two groups:Group A(smear negative)patients with diabetes(104 people),COPD(122 people),group B(smear positive)patients with diabetes(180 people),COPD(201 people),group A(smear negative)patients with diabetes,COPD ratio was lower than group B(smear positive)patients,the difference was statistically significant(P < 0.05).Comparison of combined Fengguan,lung cancer,hepatitis B,hypertension and coronary heart disease,there was no significant difference between the two groups(P> 0.05).6.Comparison of sputum etiology examination results between the two groups of patients:Twenty cases of smear-negative pulmonary tuberculosis patients were positive for culture of Mycobacterium tuberculosis,with a positive rate of 12.35%,and 29 cases with positive Gene Xpert-MTB/RIF test,the positive rate was 17.90%.Taking BD960 liquid fast culture method as the gold standard,Gene Xpert-MTB/RIF technology has a sensitivity of 90.0%,specificity is 92.3%,the positive predictive value was 62.07%,the negative predictive value is 98.50%,the agreement rate is 91.98%,prompt the two have excellent consistency.Conclusion1.Compared with smear positive pulmonary tuberculosis patients,smear negative pulmonary tuberculosis patients have lower average age,lower incidence of fever,cough and expectoration,and lower level of neutral granules.Chest CT is characterized by exudation,proliferation,fibrotic streak lesions and pleurisy,and is characterized by caseous pneumonia of lung,involvement of bilateral pulmonary lobes,involvement of more than 3 pulmonary lobes or low proportion of cavitary lesions,and small proportion of diabetes and chronic obstructive pulmonary diseases.2.Compared with bd960,Gene Xpert-MTB/RIF has the same detection effect in the diagnosis of smear negative tuberculosis. |
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