支气管镜在侵袭性肺真菌病诊断中的应用价值

Application of bronchoscopy in the diagnosis of invasive pulmonary fungal diseases

目的了解支气管镜技术在侵袭性肺真菌病(IPFD)诊断中的应用价值。方法回顾性分析2011年1月至2015年12月在北京朝阳医院住院诊断为侵袭性肺真菌病患者210例。对210例侵袭性肺真菌病病例的病史资料进行回顾性统计分析。结果侵袭性肺真菌病患者210例,其中确诊患者30例(14.3%),临床诊断患者79例(37.6%),拟诊患者101例(48.1%);男139例,女71例,平均年龄64岁。210例中行支气管镜检查患者109例,未行支气管镜患者101例,在支气管镜组确诊患者占20.2%(22/109),非支气管镜组确诊患者占14.3%(8/101)。两组的确诊率比较,支气管镜组确诊率高于非支气管镜组(P<0.05)。210例患者中痰真菌涂片及真菌培养(以下简称痰检)阳性率29.8%(59/198);支气管肺泡灌洗液(BALF)真菌涂片及真菌培养阳性率7.9%(8/101);G试验阳性率13.3%(22/166);支气管黏膜活检(EBB)阳性率22.1%(15/68);经皮肺穿刺活检术(PCNB)阳性率47.4%(9/19)。同时行痰检+G试验阳性率41.1%(65/158);同时行痰检+G试验+BALF+EBB检查阳性率57.1%(28/49)。痰检+G+BALF+EBB组的阳性率高于痰检+G组患者,两者差异有统计学意义(P<0.05);痰检+G+BALF+EBB组的阳性率与PCNB组差异无统计学意义(P>0.05)。结论支气管镜检查有助于IPFD患者确诊率的提高,联合应用包括支气管镜在内的多种检查手段有助于IPFD患者获得微生物学及组织病理学的诊断依据。

Objective To investigate the role of bronchoscopy in the diagnosis of invasive pulmonary fungal diseases（ IPFD）. Methods All cases of IPFD that met the diagnostic criteria were in Beijing Chaoyang hospital from January 2011 to December 2015. The history data of 210 cases of IPFD including clinical features,risk factors,image examination,bronchoscopy findings,results of microbiology,histopathological findings and prognosis were retrospectively analyzed. Results Among the 210 patients,30 were proven cases（ 14. 3%）,79 were probable（ 37. 6%）,and 101 were possible（ 48. 1%）. There were 139 male patients and 71 female patients. The average age was 64 years old. 157 cases of the patients survived（ 74. 8%）,30 died（ 14. 2%） and 23 withdrew from treatment（ 11. 0%）. Bronchoscopy was performed in 109 of the patients,20. 2% of the patients were proven cases（ 22/109）,only 14. 3%（ 8/101） of the patients were proven cases in the patients that didn＇t perform bronchoscopy. The proportion of proven cases in patients perform bronchoscopy was higher（ P〈0. 05）. In 210 cases,the positive rate of sputum direct microscopic examination and sputum fungus culture was 29. 8%（ 59/198）,the positive rate of direct microscopic examination and fungus culture in bronchoalveolar lavage fluid（ BALF） was 7. 9%（ 8/101）,and the positive rate of G testing was 13. 3%（ 22/166）. Endobronchial biopsy（ EBB） was 22. 1%（ 15/68）,and percutancous cutting needle biopsy（ PCNB） was 47. 4%（ 9/19）. The positive rate of sputum direct microscopic examination and sputum fungus culture ＋ G testing was 57. 1%（ 28/49）,and the positive rate of sputum direct microscopic examination and sputum fungus culture ＋ G testing ＋ BALF ＋ EBB was 57. 1%（ 28/49）（ P〈0. 05）. The difference in the positive rate of sputum direct microscopic examination and sputum fungus culture ＋ G testing ＋ BALF ＋ EBB and PCNB was not significant（ P〈0. 05）. Conclusion Bronchoscopy is valuable in the proven diagnosis of invasive pulmonary fungal diseases. The combination of various examination methods and bronchoscopy can increase the positive rate in microbiology and tissue pathology.