疑似肺结核患者分枝杆菌培养结果分析

目的分析支气管肺泡灌洗液(BALF)标本抗酸涂片阳性,且XpertMTB/RIF阴性的疑似肺结核患者的分枝杆菌培养结果并结合临床特点,以提高非结核分枝杆菌(NTM)肺病的早期诊断,减少误诊.方法选取2017年1月至2019年8月BALF标本抗酸涂片阳性且XpertMTB/RIF阴性的疑似肺结核患者43例,基于BALF分枝杆菌培养,结合患者临床资料(包括年龄、性别、既往病史、症状及胸部CT表现)、实验室检查(包括T-spot.TB实验)进行回顾性分析.结果43例患者中,88%确诊为NTM肺病;多数(60.47%)为老年患者;多数(62.79%)合并基础肺病如支气管扩张、慢性阻塞性肺病、陈旧性肺结核;T-spot.TB实验多为阴性(79.2%),临床症状及影像学表现与肺结核相似但病情进展较慢.且因NTM肺病与肺结核有较多相似点,分枝杆菌培养较慢,尤其涂片阳性患者早期易被误诊为肺结核.结论BALF标本抗酸涂片阳性,且XpertMTB/RIF阴性的患者,需高度怀疑NTM肺病,减少NTM肺病的误诊.

Objective To analyze the mycobacterium culture results of suspected tuberculosis patients with positive acid fast smear and negative xpertmtb/RIF in bronchoalveolar lavage fluid(BALF)specimens,and to improve the early diagnosis of nontuberculous Mycobacterium(NTM)lung disease and reduce misdiagnosis.Methods 43 cases of specimens of BALF acid smear positive and XpettMTB/RIF negative suspected tuberculosis patients in Wenzhou city central hospital from January 1,2017 to August 30,2019 were selected as the research objects.Based on the BALF mycobacterial culture,the clinical data,including age,sex,medical history,symptoms and chest CT performance,laboratory tests(including T-spot.T experiments)were retrospectively analyzed.Results Among the 43 patients,88%were diagnosed with NTM lung disease.The majority(60.79%)were elderly patients.Most(62.79%)were associated with underlying pulmonary diseases such as bronchiectasis,chronic obstructive pulmonary disease,and old pulmonary tuberculosis.Most of the t-spot.TB tests were negative(79.2%),and the clinical symptoms and imaging manifestations were similar to tuberculosis,but the disease progressed slowly.And because NTM lung disease and tuberculosis had many similarities,mycobacterium,culture was slow,especially smear positive patients early easy to be misdiagnosed as tuberculosis.Conclusion Patients with positive acid-resistant smear of broncho-alveolar lavage fluid specimen and negative Xpert should be highly suspicious of NTM pulmonary disease in order to reduce misdiagnosis and treatment.