Diagnosis of pulmonary tuberculosis: recent advances.
Diagnosis of pulmonary tuberculosis: recent advances.
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肺结核的诊断：最新进展。
DOI：
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发表时间：
2013
影响因子：
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通讯作者：
M. Pai
中科院分区：
文献类型：
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作者：
M. Pai
印度仍然是世界上结核病病例最多的国家，印度每年报告的病例超过200万例。印度的私营部门是结核病治疗的重要来源，超过50%的结核病患者在私营卫生部门寻求结核病治疗。早期和准确的诊断是控制结核病的第一个关键步骤。所有咳嗽持续两周或更长时间的人，或不明原因的慢性发热和/或体重减轻的人都应进行结核病评估。对于肺结核，痰液是实验室检测的最关键样本。虽然血液在印度私营部门是一种流行的样本，但没有公认的有效的肺结核血液检测。对于活动性结核病，有三种可接受的、经过验证的痰液检测：痰涂片抗酸杆菌显微镜检查;分子或核酸扩增检测（NAAT）;和培养。胸部X线检查对肺结核的诊断是有用的，但不是特异性的。因此，胸部X线摄影本身不能提供结论性诊断，需要进行痰液检测。如果痰涂片和NAAT呈阴性，并且仍然怀疑结核病，则培养是结核病最敏感的检测方法。因此，培养在诊断涂片阴性结核病和耐药结核病方面非常有用。基于血液的抗体检测（例如，IgG/IgM检测）和干扰素-γ释放测定（例如，TB Gold）不准确，不应用于肺结核诊断。事实上，印度政府禁止使用结核病血清诊断测试。
India continues to have the highest number of TB cases in the world, and over 2 million cases are reported in India every year. The private sector in India is an important source of TB care with over 50% of TB patients seeking TB treatment in the private health sector. Early and accurate diagnosis is the first critical step in controlling TB. All persons with cough lasting two weeks or more, or with unexplained chronic fever and/or weight loss should be evaluated for TB. For pulmonary TB, Sputum is the most critical sample for laboratory testing. Although blood is a popular sample in the Indian private sector, there is no accepted, valid blood test for pulmonary TB. There are three accepted, validated sputum tests for active TB: Sputum smear microscopy for acid-fast bacilli; molecular or nucleic acid amplification test (NAAT); and culture. Chest radiography is useful but is not specific for the diagnosis of pulmonary TB. Therefore, chest radiography cannot provide a conclusive diagnosis on its own, and needs to be followed by sputum testing. If sputum smears and NAATs are negative, and TB is still suspected, cultures are the most sensitive tests available for TB. Culture is therefore very useful in diagnosing smear-negative TB; and drug-resistant TB. Blood-based antibody tests (eg, IgG/IgM tests) and Interferon-gamma release assays (eg, TB Gold) are not accurate and should not be used for pulmonary TB diagnosis. In fact, use of serodiagnostic tests for TB is banned by the Government of India.