薄层CT引导支气管灌洗提高结核菌涂片和培养的阳性率

Bronchial lavage guiding with thin-CT: increased the positive rates of smear/culture in bronchus alveolus lavage fluid

目的:评价以薄层CT为引导的支气管灌洗液结核菌涂片和培养的阳性率。方法:127例痰涂片阴性肺结核患者接受经薄层CT为引导的支气管灌洗检查,分析薄层CT征象和结核菌涂片和(或)培养的结果之间的关系。结果:经薄层CT为引导的支气管灌洗液涂片和(或)培养的阳性率为51.2%(65/127)。以薄层CT征象微结节、结节、磨玻璃影及薄壁空洞、支气管扩张以及支气管规则狭窄引导下的肺叶纤维支气管镜灌洗液沉渣抗酸杆菌涂片和(或)培养阳性结果低于阴性结果,其差异有统计学意义(x2=94.76,x2=8.54,x2=29.32,x2=45.12;P<0.001);以薄层CT征象树芽征、实变、厚壁空洞、虫蚀样空洞、支气管不规则狭窄以及支气管黏液嵌塞引导下的肺叶纤维支气管镜灌洗液沉渣抗酸杆菌涂片和(或)培养阳性结果高于阴性结果,其差异有统计学意义(x2=11.93,x2=8.90,x2=18.87,x2=8.90,x2=10.78;P<0.05)。多因素回归分析显示只有厚壁空洞是灌洗阳性的独立预测因子。结论:薄层CT引导支气管灌洗可以提高结核菌涂片和培养的阳性率。

Objective： This study assessed the positive rates of smear/culture in bronchus alveolus lavage fluid（BALF） undergoing fiberoptic bronchoscopy（FBS） guiding with thin-CT sign in patients with smear negative pulmonary tuberculosis in sputum. Methods： We investigated 127 patients with smear negative pulmonary tuberculosis in sputum,who underwent FBS guiding with thin-CT sign. Association between thin-CT sign and outcome of smear/culture in BALF were analyzed. Results： The positive rates of smear/culture in BALF were 51.2%（65/127）. Guiding with micro-nodule, nodule,ground glass opacity,thinwalled cavity,bronchiectasis and regular bronchus stenosis, positive rates of smear/culture in BALF were lower than negative rates of those respectively（x2=94.76, x2=8.54, x2=29.32, x2=45.12; P0.001）; Guiding with tree-in-bud, consolidation,thick- walled cavity,mouth-eaten cavity, irregular bronchus stenosis, and bronchus mucus impaction, positive rates of smear/culture in BALF were higher than negative rates of those respectively（x2=11.93, x2=8.90, x2=18.87, x2=8.90, x2=10.78; P0.05）, Multivariate regression analysis showed that only thick- walled cavity was the independence prognosis factor of positive of smear/culture in BALF（OR=5.97, 2.48∽14.38, 95% CI, 0.001）.Conclusion： This analysis revealed that FBS guiding with thin-CT sign could increase the positive rates of smear/culture in BALF in patients with smear negative pulmonary tuberculosis in sputum.