结核病组织病理HE染色联合三种病原学检测方法对提升活动性结核病阳性率的应用价值

doi:10.19983/j.issn.2096-8493.20260072

摘要/Abstract

摘要：

目的: 探讨传统病理学苏木精-伊红染色(HE)联合抗酸杆菌(AFB)染色涂片镜检、结核分枝杆菌DNA(TB-DNA)及GeneXpert MTB/RIF(Xpert)3种病原学检测技术对提升活动性结核病阳性率的应用价值。方法: 参照入组标准收集2023年深圳市第三人民医院入院诊治的186例肺结核患者的相关临床资料(包括术后病灶病理HE染色、AFB涂片镜检、TB-DNA及Xpert检测结果),按术后病灶病理组织炎症坏死进程分类将患者分为肉芽肿性炎组(33例)、一般性坏死组(44例)、干酪样坏死组(81例)和凝固性坏死组(28例),通过比较组织病理HE染色与AFB涂片镜检、TB-DNA及Xpert检测的阳性率,评估传统组织病理HE染色联合3种病原学检测方法对提升活动性结核病阳性率的应用价值。结果: Xpert和TB-DNA检测阳性率[分别为77.96%(145/186)和64.52%(120/186)]均明显高于AFB[46.24%(86/186)],Xpert明显高于TB-DNA,差异均有统计学意义(χ²=39.757,P<0.001;χ²=12.575,P<0.001;χ²=8.199,P=0.004)。Xpert检测干酪样坏死组的阳性率最高[83.95%(68/81)],肉芽肿性炎组阳性率最低[66.67%(22/33)]。联合检测显示:HE+Xpert及4种方法联合对病理组织检测的总阳性率[分别为87.10%(162/186)、93.01%(173/186)]均高于HE+AFB染色[76.88%(143/186)],差异均有统计学意义(χ²=6.571,P=0.010;χ²=18.919,P<0.001);其中,HE+AFB检测肉芽肿性炎组、一般性坏死组、干酪样坏死组、凝固性坏死组的阳性率分别为45.45%(15/33)、77.27%(34/44)、86.42%(70/81)、85.71%(24/28), HE+Xpert检测阳性率分别为75.76%(25/33)、86.36%(38/44)、91.36%(74/81)、89.29%(25/28)。结论: 本研究从临床实际应用角度证实:精准取材+多方法联合检测是提高结核病理组织阳性率的关键策略,将Xpert等分子生物学技术常规纳入病理组织结核病诊断流程,可明显提升结核病病理诊断的阳性率,尤其是对肉芽肿性炎阳性率的提升,可为临床确诊提供重要依据。

关键词: 结核, 活组织检查, 组织细胞化学, 肉芽组织, 分子诊断技术

Abstract:

Objective: To explore the clinical value of hematoxylin-eosin (HE) staining combined with acid-fast bacilli (AFB) smear microscopy, Mycobacterium tuberculosis DNA (TB-DNA) detection and GeneXpert MTB/RIF (Xpert) assay in improving the positive detection rate of active tuberculosis in pathological tissues. Methods: Following the inclusion criteria, clinical data from 186 pulmonary tuberculosis patients admitted to Shenzhen Third People’s Hospital in 2023 were collected. The data included postoperative lesion pathological HE staining, AFB smear microscopy, TB-DNA and Xpert results. Patients were classified into four groups based on the inflammatory necrosis progression of postoperative lesions:granulomatous necrosis group (33 cases), general necrosis group (44 cases), caseous necrosis group (81 cases), and caseating necrosis group (28 cases). By comparing the positivity rates of histopathological HE staining with those of AFB smear microscopy, TB-DNA testing, and Xpert testing, we evaluated the diagnostic value of combining conventional histopathological HE staining with these three pathogen detection methods in improving the detection rate of active tuberculosis. Results: The positive rates of Xpert and TB-DNA (77.96% (145/186) and 64.52% (120/186)) were significantly higher than that of AFB staining (46.24% (86/186)) across all groups (χ²=39.757, P<0.001; χ²=12.575, P<0.001). Xpert had a higher overall positive rate than TB-DNA (χ²=8.199, P=0.004). Xpert achieved the highest positivity rate (83.95% (68/81)) in the caseous necrosis group. Whereas the granulomatous inflammation group showed the lowest positivity rate (66.67% (22/33)). The overall positive rates of HE+Xpert (87.10% (162/186)) and the four-method combination (93.01% (173/186)) were significantly higher than that of HE+AFB staining (76.88% (143/186))(χ²=6.571, P=0.010; χ²=18.919, P<0.001). Subgroup analysis revealed that single HE staining consistently yielded the low positive rates across all pathological subtypes:granulomatous inflammation (45.45%, 15/33), general necrosis (77.27%, 34/44), caseous necrosis (86.42%, 70/81), and coagulative necrosis (85.71%, 24/28). The positive rates of HE+Xpert were 75.76% (25/33), 86.36% (38/44), 91.36% (74/81), and 89.29% (25/28). Conclusion: Accurate tissue sampling combined with multi-method detection markedly improves the diagnostic positivity of tuberculous pathological testing. Routine incorporation of molecular techniques such as Xpert significantly enhance the diagnostic positive rate. This is particularly beneficial for detecting granulomatous inflammation, providing crucial evidence for clinical diagnosis.

Key words: Tuberculosis, Biopsy, Histocytochemistry, Granulation tissue, Molecular diagnostic techniques

中图分类号:

R52
R446.8

张雅曦, 喻宏, 李静, 苟继周, 杨倩婷, 詹森林, 陈骑. 结核病组织病理HE染色联合三种病原学检测方法对提升活动性结核病阳性率的应用价值[J]. 结核与肺部疾病杂志, 2026, 7(4): 487-492. doi: 10.19983/j.issn.2096-8493.20260072

Zhang Yaxi, Yu Hong, Li Jing, Gou Jizhou, Yang Qianting, Zhan Senlin, Chen Qi. Diagnostic value of combining HE staining with three pathogen detection methods in tuberculosis histopathology for improving the positivity rate of active tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(4): 487-492. doi: 10.19983/j.issn.2096-8493.20260072

图/表 2

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方法	肉芽肿性炎组(33例)	一般性坏死组(44例)	干酪样坏死组(81例)	凝固性坏死组(28例)	合计(186例)
AFB	6(18.18)	20(45.45)	46(56.79)	14(50.00)	86(46.24)
Xpert	22(66.67)	34(77.27)	68(83.95)	21(75.00)	145(77.96)
χ²值	15.880	9.394	14.329	3.733	39.757
P值^a	<0.001	0.002	<0.001	0.053	<0.001
TB-DNA	21(63.63)	29(65.91)	53(65.43)	17(60.71)	120(64.52)
χ²值	14.102	3.730	1.273	0.650	12.575
P值^b	<0.001	0.053	0.259	0.420	<0.001
χ²值	0.067	1.397	1.272	1.310	8.199
P值^c	0.796	0.237	0.259	0.252	0.004
χ²值	19.477	9.802	14.513	3.736	40.412
P值^d	<0.001	<0.001	0.004	0.155	<0.001

方法	肉芽肿性炎组(33例)	一般性坏死组(44例)	干酪样坏死组(81例)	凝固性坏死组(28例)	合计(186例)
HE	11(33.33)	30(68.18)	68(83.95)	23(82.14)	132(70.97)
HE+AFB	15(45.45)	34(77.27)	70(86.42)	24(85.71)	143(76.88)
χ²值	1.015	0.916	0.195	0.132	1.687
P值^a	0.313	0.338	0.658	0.716	0.193
HE+Xpert	25(75.76)	38(86.36)	74(91.36)	25(89.29)	162(87.10)
χ²值	6.346	1.222	1.000	0.163	6.571
P值^b	0.011	0.268	0.317	0.686	0.010
HE+TB-DNA	21(63.64)	35(79.55)	72(88.89)	24(85.71)	152(81.72)
χ²值	2.200	0.067	0.228	0.132	1.326
P值^c	0.138	0.795	0.632	0.716	0.249
4种方法	30(90.91)	40(90.91)	77(95.06)	26(92.86)	173(93.01)
χ²值	15.714	3.057	3.600	0.746	18.919
P值^d	<0.001	0.080	0.057	0.387	<0.001