结核病与肺部健康杂志 ›› 2013, Vol. 2 ›› Issue (2): 106-108.

• 论著 • 上一篇    下一篇

气管镜多指标联合检测对菌阴支气管结核患者的诊断价值

闵春燕,时翠林,叶志坚,陈兴年,吴妹英   

  1. 215007 苏州市第五人民医院呼吸内科
  • 收稿日期:2012-11-24 出版日期:2013-06-30 发布日期:2013-06-30
  • 通信作者: 吴妹英,Email:wu_my@126.com

Diagnostic value of different methods combination of bronchoscopy combination on culture negative pulmonary tuberculosis with tracheobronchial tuberculosis

MIN Chun-yan,SHI Cui-lin,YE Zhi-jian,CHEN Xing-nian,WU Mei-ying   

  1. Department of Respiratory,the Fifth People’s Hospital of Suzhou,Suzhou 215007,China
  • Received:2012-11-24 Online:2013-06-30 Published:2013-06-30
  • Contact: WU Mei-ying,Email:wu_my@126.com

摘要: 目的探讨电子支气管镜多指标联合检测对菌阴肺结核合并气管支气管结核患者的诊断价值。方法回顾性分析2010年1月至2012年8月我院诊断的78例菌阴支气管结核患者治疗前电子支气管镜下表现及气管内病变分布,并统计分析支气管镜刷检涂片、支气管肺泡灌洗液(BALF)涂片、BALF培养、病理活检及术后连续3d 痰涂片检查的结果,比较上述5种方法单独和联合检测对气管支气管结核诊断的阳性率。结果78例受检患者中72例镜检发现异常,镜下病理分型主要以炎症浸润型(Ⅰ型 100.0%,78/78),肉芽增殖型(Ⅲ型 37.2%,29/78),瘢痕狭窄型(Ⅳ型 34.6%,27/78)为主。刷检涂片、BALF涂片、BALF培养、术后痰涂片、病理活检的阳性率分别为33.3%(26/78)、39.7%(31/78)、12.8%(10/78)、26.9%(21/78)、66.7%(28/42),这5种方法单独的阳性检出率差异有显著统计学意义(χ2=38.94,P<0.01)。而细菌学联合检测的阳性率为62.8%(49/78),病理活检与细菌学联合检查的阳性率为78.2%(61/78)。结论支气管镜检查时应强调多种采样方法相互配合,减少单一检查方法的局限性,从而提高菌阴支气管结核的诊断率。

Abstract: Objective To evaluate the diagnostic value of electronic bronchoscopy in diagnosis of culture ne-gative pulmonary tuberculosis with tracheobronchial tuberculosis(TBTB).Methods The data of 78 patients of culture negative pulmonary tuberculosis with TBTB who were hospitalized in our hospital from January 2010 to August 2012 were analyzed,including the pathological classification of electronic bronchoscope and intratracheal lesions distribution before treatment. The results of brush examination,bronchoalveolar lavage fluid(BALF)smear,BALF culture,pathological biopsy and 3 sputum smear examinations after bronchoscope were compared.Results Seventy-two out of 78 cases’ electronic bronchoscope had abnormal display. And the main pathological classification were inflammatory infiltration(type Ⅰ100.0%,78/78),granulation hyperplasia(type Ⅲ 37.2%,29/78)and scar stricture(type Ⅳ34.6%,27/78).The positive rates of single test by brush,BALF smear,BALF culture,sputum smear after bronchoscope and pathological biopsy were 33.3%(26/78),39.7%(31/78),12.8%(10/78),26.9%(21/78)and 66.7%(28/42)respectively,and the differences among these five methods had statistically significance(χ2=38.94,P<0.01).The positive rate of bacteriology joint detection was 62.8%(49/78),and in biopsy combined increased significantly to 78.2%(61/78).Conclusion Comparing to single methods,different methods of bronchoscopy combination can improve the diagnosis of culture negative pulmonary tuberculosis with TBTB.