纤维支气管镜检查对无痰或痰菌阴性不典型肺结核的诊断价值

摘要/Abstract

摘要： 目的探讨纤维支气管镜（简称“纤支镜”）检查对无痰或痰菌阴性不典型肺结核的诊断价值。方法选无痰或痰菌阴性的不典型肺结核患者201例，用纤支镜在病变部位进行活检、刷检、支气管肺泡灌洗液（BALF）进行BBLMGIT(Mycobacteria Growth Indicate Tube)分枝杆菌快速培养查结核杆菌。术后进行痰涂片查抗酸杆菌、痰结核分枝杆菌快速培养。结果201例刷检、BALF快速培养结核分枝杆菌阳性率分别是67.2%、83.6%，61例活检阳性率63.9%，201例术后痰涂片、术后痰快速培养结核分枝杆菌阳性率分别是28.9%、57.2%。结论纤支镜检查是确诊无痰或痰菌阴性不典型肺结核的有效方法，其中BALF行结核分枝杆菌快速培养具有较高的诊断价值、快速、阳性率较高。根据镜下所见采用不同的取材方法可望提高诊断率。

关键词: 结核, 肺/诊断, 支气管镜检查

Abstract: Objective To study the diagnostic value of fiberoptic bronchoscopy in atypical pulmonary tuberculosis with no sputum or negative sputum smear. Methods Bronchial brushing, and rapid culture forMycobacterium tuberculosisin bronchoalveolar fluid(BALF) were performed for 201 cases with atypical pulmonary tuberculosis with no sputum or negative sputum smear and only 61 cases underwent transbronchial lung biopsy. All patients underwent sputum acid-fast staining andrapid culture forMycobacterium tuberculosisin sputum after using fiberoptic bronchoscopy. Results Of 201 cases,67.2%(135/201) were confirmed by bronchial brushing,83.6%(168/201) were confirmed by rapid culture forMycobacterium tuberculosisin BALF. Among the 61 cases underwent transbronchial lung biospy, pulmonary tuberculosis was confirmed in 39 cases(63.9%). Among the 201 cases underwent sputum acid-fast staining and rapid culture forMycobacterium tuberculosisin sputum after using fiberoptic bronchoscopy,28.9%(58/201) were confirmed by sputum acid-fast staining, 57.2%(115/201) were confirmed by rapid culture forMycobacterium tuberculosisin sputum. Conclusion Fiberoptic bronchoscopy plays an important role in the diagnosis of atypical pulmonary tuberculosis with no sputum or negtive sputum acid-fast staining,and that rapid culture forMycobacterium tuberculosisin BALF is of significant value. It may increase the diagnosic rate of atypical pulmonary tuberculosis to apply different sampling Methods according to being found by the fiberoptic bronchoscopy.

Key words: tuberculosis,pulmonary/diagnosis, bronchoscopy

常占平, 彭勋, 王洪芬, 彭卫平, 曹丽华. 纤维支气管镜检查对无痰或痰菌阴性不典型肺结核的诊断价值[J]. 中国防痨杂志, 2010, 32(3): 167-170.

ChangZhanping,Peng Xun,Wang Hongfen,Peng Weiping,Cao Lihua. Diagnostic value of fiberoptic bronchoscopy in atypical pulmonary tuberculosis with no sputum or negative sputum smear[J]. Chinese Journal of Antituberculosis, 2010, 32(3): 167-170.

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纤维支气管镜检查对无痰或痰菌阴性不典型肺结核的诊断价值

Diagnostic value of fiberoptic bronchoscopy in atypical pulmonary tuberculosis with no sputum or negative sputum smear

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