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结核菌L型(TB-L)是结核菌细胞壁缺陷的变异型,常规方法不能检出,常导致临床漏诊和误诊。作者对73例痰直接涂片阴性者,加做结核菌细菌型(LB-B)、结核菌L型(YB-L)培养,结果报告如下。1 材料与方法1.1 选例标准 我院肺科门诊及住院病人,临床诊断为肺结核,且3次痰检抗酸菌阴性。1.2 实验方法 痰取清晨深咳的肺部第1口痰,直接涂片抗酸染色、镜检,3次痰直接涂片阴性者,加做TB-B培养和TB-KL培养(1份痰加4份1mol/L NaOH,消化15 min后用1 mol/L HCl中和,3 000 r/min离心,30 min后取沉淀物培养),培养物 10～14 d可取沉淀物作涂片,抗酸染色,每张涂片检测作阴性报告者需油镜下查1000个视野。对生长丰盛者加做耐热触酶试验,初步排除非结核分枝杆菌。2 结果
Mycobacterium tuberculosis L-type (TB-L) is a variant of TB cell wall defects, routine methods can not be detected, often leading to clinical missed diagnosis and misdiagnosis. The authors of 73 cases of sputum direct smear, add TB bacterium (LB-B), TB-L (YB-L) culture, the results are reported as follows. 1 Materials and Methods 1.1 Selection criteria Our hospital outpatient and inpatient pulmonary disease, clinical diagnosis of tuberculosis, sputum and acid-fast bacilli 3 negative. 1.2 Experimental sputum taken early morning cough lung phlegm, direct smear acid-fast staining, microscopic examination, sputum direct smear three negative persons, plus do TB-B culture and TB-KL culture (1 sputum Add 4 parts of 1mol / L NaOH, digest for 15 min, neutralize with 1 mol / L HCl, centrifuge at 3000 r / min for 30 min, and then take sediment for culture for 10 min. Acid-fast staining, negative test for each smear required oil microscopic examination of 1000 fields. On the growth of those who add heat-resistant catalase test, preliminary exclusion of non-tuberculous mycobacteria. 2 results