摘要
目的探讨梯度高渗盐水雾化导痰联合支气管镜下多指标检查对菌阴不典型肺结核的诊断价值。方法对141例菌阴不典型肺结核患者进行常规痰检阴性后行梯度高渗盐水雾化导痰,对雾化导痰未能确诊的77例菌阴不典型肺结核患者进行支气管镜检查行病理活检、刷检涂片、支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)涂片、结核菌快速培养以及术后连续3d痰检,对结果分析评价。结果梯度高渗盐水雾化导痰菌阳确诊60例,其中涂片阳性19例(13.48%)、培养阳性45例(31.91%),涂片和培养同时阳性4例,总阳性确诊率42.55%;77例气管镜检查患者,镜下黏膜活检29例病理见典型结核结节,阳性率37.66%;刷检涂片25例,阳性率32.47%;BALF涂片与结核菌快速培养阳性26例,阳性率为33.77%;镜后痰检涂片与结核菌快速培养阳性16例,阳性率20.78%;总确诊率62.34%;雾化导痰联合支气管镜下多指标检查总确诊率76.60%。结论上述多种方法联合应用可明显提高菌阴不典型肺结核的诊断率,值得临床推广应用。
Objective To evaluate the diagnostic value of hypertonic saline ultrasonic atomization for induction sputum and fiberoptic bronchoscopy to atypical pulmonary tuberculosis with negative sputum. Methods A total of 141 cases of atypical pulmonary tuberculosis received ultrasonic atomization to induce sputum and 77 cases had not been diagnosed which received fiberoptic bronchoscope pathological biopsy, brush biopsy smear, bronchoalveolar lavage fluid （BALF） smear, rapid culture of mycobacterium tuberculosis and continuous detection of sputum for 3 days after bronchoscopy examination. Results Sixty cases had been diagnosed to be sputum positive tuberculosis by ultrasonic atomization to induce sputum, including smear 13. 48% and Mycobacterium tuberculosis culture 31.91% , and accounted for 42.55% ;Seventy-seven cases had been diagnosed by fiberoptic bronchoscopy including pathological biopsy 37.66% ,brush biopsy smear 32.47%, BALF smear and rapid identifiction of Mycobacterium tuberculosis 33. 77%, sputum smear and rapid identifiction of Mycobacterium tuberculosis after bronchoscopy 20.78% ;and accounted for 62.34% ;while the concordance was 76.60% when multiple methods were used together. Conclusion The combination of the above multiple methods is worthy to be popularized and applied, which can increaser the diagnosis rate of pulmonary tuberculosisobviously.
出处
《河北医科大学学报》
CAS
2013年第6期639-642,共4页
Journal of Hebei Medical University
基金
秦皇岛市科技局支撑计划(200815)
关键词
结核
肺
痰
支气管镜检查
诊断
tuberculosis, pulmonary
sputum, bronchoscopy
diagnosis
