1262例拟似肺结核患者痰液性状及排菌量分析

Analysis of Sputum Characteristics,Discharge Capacity of Bacteria Among 1262 Cases of Incipient Tuberculosis Patients(with 335 Cases Confirmed)

目的探讨拟似肺结核初次发病(初发)和初发肺结核患者,不同性质的痰标本的结核分枝杆菌涂片阳性分布(涂阳)对结果的影响,提高诊断的准确性。方法 1262例拟似肺结核初发患者,其中927例最终排除了肺结核。335例确诊为初发肺结核的患者。比较了3751份痰液标本的性状、结核分枝杆菌数量分级,确诊患者的涂片和培养阳性率。结果初发结核患者中,涂片阳性占75.2%,培养阳性占83.9%。分别为涂片培养双阳性60.30%,单涂片阳性15.52%,单培养阳性24.18%,培养的阳性率明显高于涂片(P<0.05)。不同痰标本的涂片阳性率分别是:血样痰42.70%;干乳样痰40.10%;较黏液痰32.60%;气管镜痰液27.50%;水样痰17.40%差异有统计学意义(P<0.01)。结核分枝杆菌阳性数量分级分布为:干乳样痰、血样菌痰、黏液样痰4级多见;水样痰、气管镜1级多见。结论初发病人痰培养与痰涂片二者都应重视,可增加涂片次数。不同性状的痰分级可以观察到排菌量的不同,重视干乳样、黏液样痰检查,水样痰检查不能忽视,不能过分依赖血样痰作诊断。

Objective To investigate the influence of positive distribution of mycobacterium tuberculosis＇s smear of sputum sample of different character from the suspected first tuberculosis attack patients and first tuberculosis attack patients,and to improve the accuracy of diagnosis.Methods Among 1262 samples of suspected first tuberculosis attack,927 samples were excluded finally,335 samples were confirmed cases.3751 sputum samples from the confirmed cases in terms of positive smear cultivation,sputum character and the number of mycobacterium tuberculosis were analyzed.Results Among the first tuberculosis attack patients,smear positive was 75.2%,cultivation positive was 83.9%.Smear cultivation double positive was 60.3%,single smear positive was 15.52%,single cultivation positive was 24.18%.Cultivation positive rate was obviously higher than that of smear（P0.05）.Smear positive rate of different sputum samples were：blood sputum 42.7%,dried emulsion sputum 40.10%,mucous sputum 32.6%,bronchoscope 27.5%,water like sputum 17.4%（P0.01）.Number distribution of positive mycobacterium tuberculosis were：dried emulsion sputum,blood like sputum,mucous sputum of level 4 were common,water like sputum,and bronchoscope of level 1 were common.Conclusion Both cultivation of sputum and smear of sputum from first tuberculosis attack patients needed to be valued.Different classification of sputum caused different amount of bacteria discharging.The inspection of dried emulsion sputum and mucous sputum as well as water like sputum should be paid attention to.Do not overly rely on the blood sputum in diagnosis.