164例气管支气管结核临床病理特征及病原学检测结果分析

doi:10.3969/j.issn.2095-3755.2019.02.013

摘要/Abstract

摘要：

目的探讨气管支气管结核(TBTB)的临床病理特征及病原学检测价值。方法选取2017年1—12月陕西省结核病防治院收治的164例TBTB患者作为研究对象,收集患者一般信息及CT扫描图像、组织活检、痰检、MTB培养及GeneXpert MTB/RIF(简称“GeneXpert”)检测结果。分析TBTB临床及CT表现特征、支气管镜下病变类型、组织病理学特点,以及病原学检测结果。结果 164例研究对象中咳嗽153例(93.29%),发热108例(65.85%);病变部位以右侧为主109例(66.46%)。CT扫描主要表现为管腔不规则狭窄92例(56.10%),管壁不规则增厚45例(27.44%),肺门或近肺门软组织块影27例(16.46%)。支气管镜检查主要表现为炎症浸润型[69例(42.07%)]、溃疡坏死型[46例(28.05%)]和肉芽增殖型[29例(17.68%)]。组织病理学改变表现为渗出性病变46例(28.05%)、增生性病变32例(19.51%)、坏死性病变36例(21.95%)、复合性病变50例(30.49%)。85例研究对象同时进行了组织与痰液抗酸染色、MTB培养和GeneXpert检测,抗酸染色+GeneXpert+MTB培养检测阳性率为57.65%(49/85),明显高于抗酸染色阳性率[37.65%(32/85)],差异有统计学意义(χ ²=6.82,P=0.009)。结论 TBTB支气管镜及病理表现多样,不同病原学检测方法的阳性率差别大,其诊断应结合临床、CT表现及病理表现并联合多种病原学检测结果综合分析。

关键词: 结核, 支气管, 病理状态, 体征和症状, 诊断技术和方法

Abstract:

Objective This study aimed to investigate the clinicopathologic features and pathogenic detection value of tracheobronchial tuberculosis (TBTB).Methods Totally, 164 patients with TBTB were enrolled in Shaanxi Provincial Tuberculosis Control Hospital from January to December 2017. The general information, CT scan image, tissue biopsy, sputum test, MTB culture and GeneXpert MTB/RIF (GeneXpert) detection results were collected. Then the clinical and CT imaging features, the type of lesions under bronchoscopy, histopathological features, and pathogenic detection results of TBTB patients were analyzed.Results Among 164 subjects, 153 (93.29%) had cough and 108 (65.85%) had fever; and the lesions of 109 cases (66.46%) were predominantly on the right side. CT scan mainly showed irregular lumen stenosis in 92 cases (56.10%), irregular wall thickening in 45 cases (27.44%), and hilar or near-lung soft tissue shadow in 27 cases (16.46%). Bronchoscopy mainly exhibited inflammatory infiltration (69 cases (42.07%)), ulcer necrosis (46 cases (28.05%)), and granulation proliferation (29 cases (17.68%)). Histopathological changes showed 46 cases of exudative lesions (28.05%), 32 cases of proliferative lesions (19.51%), 36 cases of necrotic lesions (21.95%), and 50 cases of complex lesions (30.49%). Eighty-five subjects all underwent acid-fast staining in tissue and sputum, MTB culture and GeneXpert test. The positive rate of acid-fast staining+GeneXpert+MTB culture was 57.65% (49/85), which was significantly higher than that of acid-fast staining (37.65% (32/85)), with a significant statistical difference (χ ²=6.82, P=0.009).Conclusion TBTB patients exhibit diverse bronchoscopy and pathological features, and the positive rates of different pathogenic detection methods are quite different. These results indicated that TBTB should be diagnosed based on the comprehensive analysis, including clinicopathologic features, CT imaging and various pathogenic detection results.

Key words: Tuberculosis, Bronchial, Pathological conditions, signs and symptoms, Diagnostic techniques and methods

杨莉,杨宗成,仵倩红,王景民,段文,刘丽. 164例气管支气管结核临床病理特征及病原学检测结果分析[J]. 结核病与肺部健康杂志, 2019, 8(2): 138-141. doi: 10.3969/j.issn.2095-3755.2019.02.013

Li YANG,Zong-cheng YANG,Qian-hong WU,Jing-min WANG,Wen DUAN,Li LIU. Clinicopathologic features and pathogenic detection of 164 cases with tracheobronchial tuberculosis[J]. Journal of Tuberculosis and Lung Health, 2019, 8(2): 138-141. doi: 10.3969/j.issn.2095-3755.2019.02.013

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检测方法	阳性(例)	阳性率(%)	χ²值^a	P值^a
抗酸染色	32	37.65	-	-
MTB培养	17	20.00	6.45	0.011
GeneXpert	44	51.76	3.43	0.064
抗酸染色+MTB培养	35	41.18	0.22	0.638
抗酸染色+GeneXpert	45	52.94	4.01	0.045
抗酸染色+GeneXpert+MTB培养	49	57.65	6.82	0.009