摘要
目的评估影像学、免疫学和相关炎性指标联合检测辅助诊断煤工尘肺合并涂阴肺结核的临床价值,为其早期诊断提供依据。方法选取2017年1月-2020年12月在北京京煤集团总医院职业病科诊治的61例煤工尘肺合并涂阴肺结核患者作为观察组,以同期诊治的49例非合并涂阴肺结核的煤工尘肺患者作为对照组。两组患者均于入院次日行胸部CT、结核菌素试验、γ-干扰素释放试验、结核抗体、血常规、血沉、血C反应蛋白检测。采用平行或系列的方法,评估相关指标联合检测的敏感性、特异性、诊断正确率等。结果观察组胸部CT结节、团块、团块周围卫星灶、斑片、空洞、胸腔积液、胸膜增厚、淋巴结增大等征象的检出率均高于对照组;其三项结核病相关免疫学检测阳性率、单核细胞计数、单核细胞与淋巴细胞比值、血沉、C反应蛋白数值均高于对照组。单项指标辅助诊断煤工尘肺合并涂阴肺结核时,胸部CT斑片影敏感性最高(80.3%),胸部CT团块周围卫星灶和单核细胞计数>0.6的特异性(均为95.9%)最高,γ-干扰素释放试验的诊断正确率最高(71.8%)。采用平行方法将影像学指标与免疫学或炎性指标联合辅助诊断时,胸部CT团块影或γ-干扰素释放试验阳性的诊断正确率最高(82.73%)。采用系列方法将影像学指标与免疫学或炎性指标联合辅助诊断时,胸部CT团块影联合γ-干扰素释放试验阳性、团块影联合C反应蛋白>5(mg/L)的特异性最高,均为97.96%,而胸部CT斑片影联合γ-干扰素释放试验阳性的诊断正确率最高(69.09%)。结论影像学与免疫学、炎性指标联合检测,有助于尘肺合并涂阴肺结核的早期诊断。其中,胸部CT团块或斑片影与γ-干扰素释放试验是最佳组合指标。
Objective To evaluate the clinical value of combined detection of imaging,immunology and related inflammatory indicators in the auxiliary diagnosis of coal workers’pneumoconiosis with smear negative pulmonary tuberculosis,and to provide evidence for its early diagnosis.Methods A total of 61 coal workers’pneumoconiosis patients with smear negative pulmonary tuberculosis diagnosed and treated in the occupational disease department of Beijing Jingmei Group General Hospital from January 2017 to December 2020 and 49 patients with coal workers’pneumoconiosis who were not combined with smear-negative pulmonary tuberculosis were taken as control group.Chest CT,tuberculin test,interferon-γrelease assay,tuberculosis antibody,blood routine test,erythrocyte sedimentation rate,blood C-reactive protein test.The sensitivity,specificity and diagnostic accuracy of the combined detection of related indicators were evaluated by parallel or serial methods.Results The detection rate of chest CT nodules,masses,satellite lesions around the masses,patches,cavities,pleural effusion,pleural thickening,lymph node enlargement and other signs in observation group was higher than that in control group;The positive rate of three tuberculosis related immunological tests,monocyte count,ratio of monocytes to lymphocytes,erythrocyte sedimentation rate and C-reactive protein were higher than those in control group.When a single index was used to assist in the diagnosis of coal worker’s pneumoconiosis with smear negative pulmonary tuberculosis,the sensitivity of the chest CT patch was the highest(80.3%),and the specificity of the satellite focus and monocyte count around the chest CT mass was the highest(95.9%),interferon-γrelease assay was the highes(t 71.8%).When the imaging index and immunology or inflammation index are combined to assist the diagnosis by parallel method,the chest CT mass image or the diagnostic accuracy of interferon-γrelease assay was the highest(82.73%).When using a series of methods to combine imaging indicators with immunological or inflammatory indicators for auxiliary diagnosis,chest CT mass image is combined the specificity of interferon-γrelease test positive,lump shadow combined with C-reactive protein>5(mg/L)was the highest,which was 97.96%,while the specificity of chest CT patch shadow combined the diagnostic accuracy of IFN-γrelease test was the highest(69.09%).Conclusion The combined detection of imaging,immunology and inflammatory indexes is helpful for the early diagnosis of pneumoconiosis with smear negative pulmonary tuberculosis.Among them,the mass or patch image of chest CT withγ-Interferon release test is the best combination index.
作者
李月
杨晓丽
王兆丰
吕洋
苗志远
李琦
LI Yue;YANG Xiaoli;WANG Zhaofeng;LV Yang;MIAO Zhiyuan;LI Qi(不详;Beijing Chest Hospital,Capital Medical University,Tuberculosis Department,Beijing 102308,China)
出处
《工业卫生与职业病》
CAS
2023年第5期411-415,共5页
Industrial Health and Occupational Diseases
关键词
分枝杆菌
肺结核
尘肺
涂阴
诊断
Mycobacterium
Pulmonary tuberculosis
Pneumoconiosis
Smear negative
Diagnosis
