华西医学

华西医学

经验医学向精准医学的转变——《肺结核诊断》(WS 288-2017)解读

查看全文

对《肺结核诊断》(WS 288-2017)从医学模式变迁的角度,就肺结核分类、诊断标准、诊断内容 3 个方面进行解读,指出肺结核分类中新增加气管支气管结核和结核性胸膜炎,诊断标准强调了结核分子生物学和病理学检查结果的诊断价值,并在内容中新增了耐药状况。最后从可行性和发展趋势方面提出 2 点建议:基层地区仍可考虑保留诊断性治疗等实用技术作为诊断依据,有条件的单位则需开拓新的分子技术增加结核杆菌 DNA/RNA 鉴定、耐药基因检测以利精准诊断。

Basing on development of medical model, new national diagnostic standard is interpreted according to three aspects: classification, diagnostic standard, and diagnostic contents. Tracheobronchial tuberculosis and tuberculous pleurisy are added into the classification. The value of molecular and pathological techniques for diagnosis of the pulmonary tuberculosis is emphasized. The status of drug-resistance is included in the diagnostic content. Two opinions are suggested: some practical methods such as diagnostic chemotherapy are indicated in some grassroots areas, while new molecular techniques for detection of DNA/RNA of mycobacteria and resistant mutation are encouraged in some suitable institutions.

关键词: 肺结核; 诊断标准; 精准医学

Key words: Pulmonary tuberculosis; Diagnostic standard; Precision medicine

引用本文: 陈雪融, 陈效友. 经验医学向精准医学的转变——《肺结核诊断》(WS 288-2017)解读. 华西医学, 2018, 33(8): 950-952. doi: 10.7507/1002-0179.201807076 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. 中华人民共和国国家卫生和计划生育委员会. 肺结核诊断: WS 288-2017. (2017-11-09)[2018-06-01]. http://www.nhfpc.gov.cn/ ewebeditor/uploadfile/2017/12/20171212154852389.pdf.
2. 中华人民共和国国家卫生和计划生育委员会. 结核病分类: WS 196-2017. (2017-11-09)[2018-06-01]. http://www.nhfpc.gov.cn/ ewebeditor/uploadfile/2017/12/20171212154717348.pdf.
3. 刘毅, 张旭霞, 张雨晴, 等. 结核分枝杆菌三种蛋白在结核病血清学诊断中的评价研究. 中国防痨杂志, 2017, 39(8): 815-820.
4. Xiao JN, Xiong Y, Chen Y, et al. Determination of lipoprotein Z-specific IgA in tuberculosis and latent tuberculosis infection. Front Cell Infect Microbiol, 2017, 7(7): 495.
5. 李为民, 刘伦旭. 呼吸系统疾病的基础与临床. 北京: 人民卫生出版社, 2017.
6. World Health Organization. Global tuberculosis report 2017: WHO/HTM/TB/2017.23. Geneva: World Health Organization, 2017. http://www.who.int/tb/publications/global_report/en/.
7. Dorman SE, Schumacher SG, Alland D, et al. Xpert MTB/RIF ultra for detection of mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study. Lancet Infect Dis, 2018, 18(1): 76-84.
8. Ou X, Li Q, Xia H, et al. Diagnostic accuracy of the PURE-LAMP test for pulmonary tuberculosis at the county-level laboratory in China. PLoS One, 2014, 9(5): e94544.
9. Gui X, Xiao H. Diagnosis of tuberculosis pleurisy with adenosine deaminase (ADA): a systematic review and meta-analysis. Int J Clin Exp Med, 2014, 7(10): 3126-3135.
10. Kim HJ, Lee HJ, Kwon SY, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest, 2006, 129(5): 1253-1258.
11. Udwadia ZF, Sen T. Pleural tuberculosis: an update. Curr Opin Pulm Med, 2010, 16(16): 399-406.
12. Conde MB, Loivos AC, Rezende VM, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Resp Crit Care Med, 2003, 167(5): 723.
13. Klimiuk J, Krenke R, Safianowska A, et al. Diagnostic performance of different pleural fluid biomarkers in tuberculous pleurisy. Adv Exp Med Biol, 2015, 852: 21-30.
14. Jiang F, Huang W, Wang Y, et al. Nucleic acid amplification testing and sequencing combined with acid-fast staining in needle biopsy lung tissues for the diagnosis of smear-negative pulmonary tuberculosis. PLoS One, 2016, 11(12): e0167342.