支气管内膜结核37例临床分析及诊断方法学比较

Clinical analysis of 37 cases with endobronchial tuberculosis and the comparison of diagnostic methods.

目的探索支气管内膜结核(EBTB)的纤维支气管镜(纤支镜,FB)下类型及诊断方法学。方法分析37例确诊的EBTB患者的临床表现、胸部X线(CT)、纤支镜检查结果,作单纯痰抗酸杆菌培养、钳取病变部位行病理学检查及刷检病变部位涂片找抗酸杆菌,并(或)作抗酸杆菌培养。结果37例中主要症状包括:咳嗽31例,发热9例,咯血10例,胸痛8例,气促5例,消瘦3例。1例出现喘息。3例的X线表现正常,只有1例的CT检查结果提示EBTB。纤支镜检查示37%的病例有炎症浸润型病变,9%有增殖型病变,27%有狭窄闭塞型病变,16%有溃疡型病变,11%大致正常。37例痰涂片行抗酸染色者中4例阳性,37例行活组织检查者中25例证实为结核,37例行纤支镜刷检涂片找抗酸杆菌检查者中33例阳性,另外4例阴性再经刷检病变组织作抗酸杆菌培养均为阳性。这三种诊断方法的检出率分别为11%,68%,89%经Χ2检验,认为这三种不同检查方法的检出率不同,即FB涂片最高,单纯痰菌涂片最低。结论EBTB缺乏特异性临床表现,胸部X线表现正常不能排除EBTB,CT诊断价值不高,单纯痰抗酸杆菌培养检出率低,确诊主要依靠纤支镜检查。对不明原因低热和呼吸道症状经积极治疗无效者,应怀疑EBTB而及时行纤支镜检查。刷检病变组织作抗酸杆菌培养检出率高,但抗酸杆菌培养时间长;镜下常规刷检找抗酸杆菌和组织活检阳性率较高,且简便快捷,值得推广。

Objective To investigate the types of endobronchial tuberculosis （EBTB） under the fiberoptic bronchoscope and compare the diagnostic methods. Methods Clinical symptoms, chest X - ray/CT manifestations, fiberoptic bronchoscopic findings of 37 patients with EBTB were analysed ; Sputum culture for acid -fast bacteria, bronchial biopsy for pathological examination, bronchescopic brush bioptic smears and culture for acid-fast bacteria were performed. Results The main symptoms were as follows： cough in 31 cases, fever in 9 cases, hemoptysis in 10 cases, plenral pain in 8 cases, breathlessness in 5 cases, weight loss in 3 cases , wheezing in 1 cases. Chest X - ray was normal in 3 cases, and CT was indicative of EBTB in only 1 case. Bronchoscopic results showed inflammatory/nfiltration in 37% of the cases, proliferative lesions in 9%, stenostic/occlusive lesions in 27%, ulcerative lesions in 16%, and apparently normal in 11%. Positive results of sputum acid -fast staining were obtained in 4 out of 37 cases. Tuberculosis was diagnosed in 25 out of 37 cases by bronchial biopsies and in 33 out of 37 cases by bronchescopic brush bioptic smears, the 4 smears negative cases were positive for bronchoscopic brush bioptic culture. The detection rates of the three methods were 11% ,68% and 89%, respectively, the differences were significant （ X2 test）, the rate of fiberoptic bronchoscopic being the hightest, the rate of sputum culture being the lowest. Conclusion The clinical features of EBTB are non - specific, and EBTB can not be excluded only by norreal chest X - ray findings. The diagnostic value of CT isn t high, the detection rate of the sputum culture for acid - fast bacilli is low, the diagnosis of the disease mainly depended on fiberoptic bronchoscopy. EBTB should be suspected and early fibereoptic bronchoscopy be performed, in patients with low - grade fever of unknown origin and when respiratory symptoms do not respond to aggressive treatment. The detection rate of bronchescopic brush bioptic culture is high, but it takes a long time. Bronchoscopic brush bioptic smears for acid - fast bacteria and bronchial biopsy is simple and rapid, with a high positive rate for the definite diagnosis of EBTB, deserve recommendation.