支气管镜多指标联合检测对菌阴肺结核的诊断价值探讨

Diagnostic value of bronchoscopy combined use of multiply methods in patients with pulmonary tuberculosis

目的探讨支气管镜多指标联合检测对菌阴肺结核的诊断价值。方法138例菌阴肺结核患者治疗前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(BALF)涂片、BALF培养以及术后连续3d痰涂片检查,了解不同取材方法对肺结核诊断的阳性率。结果43例患者镜下有异常改变,其中28例行活检19例病理为典型结核结节,活检阳性率为67.8%,刷检涂片、BALF涂片、BALF培养、术后痰涂片的阳性率分别为32.6%、36.9%、12.3%和21.0%,四者联合检测的阳性率为52.1%,活检与细菌学联合检测阳性率为63.0%。结论支气管镜检查直接观察气道有无内膜结核而诊断是否肺结核,多项指标联合检测可提高肺结核的诊断率。

[Objective] To determine the diagnostic value of bronehoseopy in diagnosis of bacteriological negative pulmonary tuberculosis. [Methods] Bronehoseopy was performed in all 138 patients, including brush examining, bronchus alveolus lavage （BAL）, tissuel live test and sputum spear acid-fast stain test. [Results] In 19 out of 28 eases the pathological biopsy was diagnosed tuberculosis, and the positive detection rates of single test by brush examining, BALF smear, BALF culture, tissuel live test and phlegm test after bronehoseope were 32.6%, 36.9%, 12.3%, 21% respectively. In combined examination the positive rates increased remarkblely to 63%. [ Conclusions ] Bronehoseopy could improve accuracy of diagnosis rate of smear negative pulmonary tuberculosis. Brush examining, bronehusalveolus lavage, tissuel live test and phlegm test after bronehoseope are supplementary for improving the diagnosis rate.