摘要目的 研究痰涂片阳性(简称涂阳)结核病患者不同标本涂片与罗氏培养阳性率的差别,探讨痰涂片和痰培养的标本选择标准.方法 回顾性分析2007年全国结核病耐药性基线调查纳入的结核病涂阳患者中3813例的痰涂片和培养结果,比较即时痰、夜痰和晨痰的涂片和培养阳性率,以及每300个视野中检测出1～2条抗酸杆菌的标本培养阳性率.两两比较采用χ2检验.结果 即时痰、夜间痰和晨痰的涂片阳性率分别为75.2%(2868/3813)、87.9%(3350/3813)和89.4%(3408/3813);同一病例的3份痰涂片均为阳性者占64.5%(2460/3813),2份涂片为阳性者占23.4%(893/3813),仅1份痰涂片为阳性者占12.1%(460/3813);即时痰加晨痰的涂片累积阳性率是3份痰涂片阳性率的96.9%(3695/3813),即时痰、夜间痰和晨痰的培养阳性率分别为97.8%(1654/1691)、96.7%(3006/3107)和97.2%(2473/2543);涂阳病例2份痰比1份痰的培养阳性率仅提高1.7%～2.8%;300个视野中检出1～2条抗酸杆菌的痰标本中90%(98/109)为痰培养阳性.结论 如采集即时痰和晨痰用于初诊者诊断,可将涂片检查3份痰标本改为2份;按照涂阳标本优先培养的原则,初诊涂阳患者培养可以由2份标本改为1份标本;涂片检查结果为每300个视野1～2条抗酸杆菌时具有一定诊断价值.

abstractsObjective To study the positive rate of smear and culture in different sputa from smearpositive patients with tuberculosis,and to discuss the criteria of sputum selection for smear and culture.Methods The results of smear and culture of sputum samples from 3813 cases during tubercuiosis drugresistance baseline survey in 2007 were retrospectively analyzed.The positive rates of smear and culture of spot sputum,night sputum and morning sputum were compared,and the culture positive rate of sputum samples with 1-2 acid fast bacilli(AFB)/300 fields was summarized.The χ2 teat was used for comparison.Results The smear positive rate of spot sputum,night sputum,and morning sputum wag 75.2%(2868/3813),87.9%(3350/3813),and 89.4%(3408/3813)respectively.The percentage of cases which were positive for all the 3 sputum samples was 64.5%(2460/3813),while that for 2 samples and 1 sample was 23.4%(893/3813)and 12.1%(460/3813)respectively.The cumulative smear positive rate of spot sputum plus morning sputum reached 96.9%(3695/3813)of the rate combined from the 3 sputum samples.The culture positive rate of spot sputum,night sputum,and morning sputum was 97.8%(1654/1691),96.7%(3006/3107)and 97.2%(2473/2543)respectively.For the smear positive cases,the positive rate of 2 sputum culture increased only 1.7%-2.8%compared with that of 1 sputum culture.The culture positive rate of samples with a smear result of 1-2 AFB/300 fields was 90%(98/109).Conclusions When spot sputum and morning sputum are collected for the diagnosis,the humber needed for smear can be decreased from 3 to 2.For smear-positive cases,if sputum is selected for culture according to the smear result,the number needed for culture can be decreased from 2 to 1.A smear result of 1-2 AFB/300 fields is of considerable diagnostic value for tuberculosis.