摘要
目的探讨呼吸内镜下黏膜活检术中应用快速现场评价(ROSE)技术在儿童活动性肺结核的诊断价值。方法回顾性分析2017年6月至2020年1月山东大学齐鲁儿童医院呼吸介入科收治的活动性肺结核40例患儿临床资料。结果1.在40例患儿中,33例气管支气管结核,7例结核性胸膜炎,其中9例为诊断困难病例。2.气管支气管结核33例,包括24例(72.7%)干酪样坏死物破溃入管腔,9例(27.3%)黏膜肿胀、外压;支气管黏膜活检快速现场细胞学评价(C-ROSE)为肉芽肿、淋间类上皮细胞、淋巴细胞浸润改变;不同部位快速现场微生物学评价(M-ROSE)阳性不一:干酪坏死处阳性6例次(13.6%,6/44例次),肉芽增生处阳性4例次(12.5%,4/32例次),充血水肿处阳性2例次(22.2%,2/18例次),黄白色坏死物处阳性0例次,病变与正常黏膜交界处阳性54例次(81.8%,54/66例次);黏膜病理均为肉芽肿、渗出、坏死改变,其中22例结核性肉芽肿,5例特征性结核结节,11例抗酸染色阳性。3.结核性胸膜炎7例患儿,胸腔镜下为胸膜黏连严重,胸膜充血、水肿,4例临床诊断困难的病例清理黏连带后见胸膜散在分布干酪样粟粒结节;胸腔镜下活检C-ROSE以坏死、组织细胞为主要表现,见多核巨细胞,但肉芽肿少见;不同部位M-ROSE结果:粟粒样结节处阳性8例次(占80.0%),黏连带处阳性0例次,充血水肿处阳性2例次(14.3%);活检病理提示肉芽肿、坏死改变,其中3例特征性结核结节,2例抗酸染色阳性。4.应用下一代测序技术(NGS)和结核分枝杆菌/利福平耐药实时荧光定量核酸扩增检测技术(Xpert MTB/RIF)检测19例患儿标本的病原微生物,其中NGS阳性7例(36.8%),Xpert MTB/RIF阳性8例(42.1%),NGS和Xpert MTB/RIF均阳性5例(26.3%)。结论呼吸内镜联合ROSE技术在儿童活动性肺结核病早期诊断方面具有重要的临床指导意义。
Objective To investigate the diagnostic value of rapid on-site evaluation(ROSE)technique in the mucosal biopsy under respiratory endoscopy in children with active tuberculosis.Methods Clinical data of 40 patients with active tuberculosis diagnosed in Department of Respiratory Intervention,Qilu Children′s Hospital,Shandong University from June 2017 to January 2020 were retrospectively analyzed.Results(1)There were 33 cases of tracheobronchial tuberculosis and 7 cases of tuberculous pleurisy in the 40 cases,among them 9 cases were difficult to diagnose.(2)Among 33 cases of tracheobronchial tuberculosis,24 cases(72.7%)of caseous necrosis breaking into the lumen,and 9 cases(27.3%)of mucosal swelling and external pressure.Cytological ROSE(C-ROSE)showed granuloma,epithelioid cells and lymphocytic infiltration with all bronchial mucosal biopsies.Different positives results of microbiological ROSE(M-ROSE)in different biopsy parts:positive results were found 6 times at caseous necrosis(13.6%,6/44 times),4 times at granulation hyperplasia(12.5%,4/32 times),2 times at hyperemia and edema(22.2%,2/18 times),0 time at yellow-white necrosis,and 54 times at the junction between lesions and normal mucosa(81.8%,54/66 times).The mucosal pathology showed granuloma,exudation and necrosis,including 22 cases with tuberculous granuloma,5 cases with characteristic tuberculous nodules,and 11 cases with positive acid-fast staining.(3)Seven cases of tuberculous pleurisy,serious pleural adhesion,pleural hyperemia and edema were observed under thoracoscopy.After clearing the adhesive tape,scattered caseous miliary nodules were found in pleura in 4 cases with a difficult clinical diagnosis.The C-ROSE of smear on thoracoscopic biopsy were characterized by necrotic and histopathic cell,with multinucleated giant cells,but granuloma was rare.M-ROSE in different parts:8 times positive for millet nodules(80.0%),0 time positive for adhesion band,2 times positive for congestion oedema(14.3%);biopsy pathology showed granuloma and necrosis,with 3 case
作者
刘霞
孟晨
马静
王超
董春华
张利红
韩琳琳
张忠晓
Liu Xia;Meng Chen;Ma Jing;Wang Chao;Dong Chunhua;Zhang Lihong;Han Linlin;Zhang Zhongxiao(Department of Respiratory Intervention,Qilu Children′s Hospital,Shandong University,Jinan 250012,China;Department of Radiology,Qilu Children′s Hospital,Shandong University,Jinan 250012,China;Department of Pathology,Qilu Children′s Hospital,Shandong University,Jinan 250012,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2021年第18期1412-1416,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
山东省自然科学基金(ZR2013HM002)。
关键词
儿童
活动性肺结核
支气管镜
胸腔镜
快速现场评价
Child
Active tuberculosis
Bronchoscope
Thoracoscope
Rapid on-site evaluation
