经皮肺活检组织病理、微生物培养及快速现场评价对肺部感染性疾病的诊断价值

Diagnostic performance of pathology,culture and ROSE of lung biopsy for suspected pulmonary infectious diseases

目的探讨CT引导经皮肺活检(PTLB)组织病理、微生物培养及快速现场评价(ROSE)对肺部感染性疾病的诊断价值.方法回顾性收集温州医科大学附属第一医院2016年1月至2018年6月因不明原因肺部病变收住院,行CT引导PTLB,送检组织病理、微生物培养或ROSE,最终诊断为肺部感染性疾病的病例.收集病例基本信息、临床症状、影像表现、诊断方法、并发症及是否更改治疗方案,比较组织病理、微生物培养及ROSE的诊断敏感度.结果共纳入529例患者,其中男354例,女175例,年龄(59±14)岁(范围:16~85岁).诊断肺结核197例、非结核分枝杆菌肺病8例、真菌性肺炎129例(肺隐球菌病95例、肺曲霉病27例、肺部马尔尼菲篮状菌病3例、肺念球菌病1例、肺部丝状真菌病3例)、细菌性肺炎39例、病原体不明性肺炎156例.同时送检组织病理与微生物培养的417例中,组织病理和微生物培养的敏感度分别为35.0%(146/417)和45.6%(190/417),联合诊断敏感度为62.8%(262/417).137例送检ROSE,ROSE对感染性疾病的诊断敏感度达51.8%(71/137).肺穿刺最常见的并发症为气胸26.1%(138/529).529例中,56.1%(297/529)的病例明确诊断后予目标治疗,43.9%(232/529)的病例维持原治疗方案.结论CT引导PTLB组织病理、微生物培养及ROSE对肺部感染性疾病具有较高的诊断价值.

Objective To explore the diagnostic performance of CT guided percutaneous lung biopsy(PTLB)with pathology,culture and rapid on-site evaluation(ROSE)in patients with pulmonary infectious diseases.Methods From January 2016 to June 2018,a retrospective study was implemented in the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University.Patients who received PTLB,suspected with lung infection were included.The basic information,clinical symptoms,imaging findings,diagnostic methods,complications,and changes in treatment of cases were collected.The diagnostic sensitivity of histopathology,microbial culture,and ROSE were evaluated at the same time.Results A total of 529 cases were enrolled,including 354 males and 175 females,(59±14)years old in average.Tuberculosis was identified in 197 cases,non-tuberculosis mycobacteria(NTM)pulmonary disease in 8,cryptococcosis in 95,pulmonary aspergillosis in 27,filamentous fungal pneumonia in 3,talaromyces marneffei pulmonary infection in 3 and pulmonary candidiasis in 1,bacterial pneumonia in 39,and pathogen were unknown in 156 cases.A total of 417 cases were submitted for histopathology and microbial culture at the same time,the diagnostic value of pathology and microbial culture were 35.0%(146/417)and 45.6%(190/417),respectively.Combined pathology with microbial culture,the diagnostic value increased to 62.8%(262/417).The diagnostic accuracy of ROSE was 51.8%(71/137).The most common complication of PTLB was pneumothorax 26.1%(138/529).56.1%(297/529)of the patients received targeted treatment after the diagnosis was confirmed,and 43.9%(232/529)maintained the original treatment.Conclusion The pathology,microbial culture,and ROSE of PTLB have relative high diagnostic value for pulmonary infectious diseases.