经支气管镜防污染采样刷检在儿童难治性肺炎病原学诊断中的价值

Clinical value of bronchoscope anti-pollution sampling and brushing in the pathogenic diagnosis of refractory pneumonia in children

目的比较痰培养、支气管肺泡灌洗(BAL)和经支气管镜防污染采样刷检3种取材方法进行细菌培养的敏感性和准确性,以探讨经支气管镜防污染采样刷检在儿童难治性肺炎(RP)病原学诊断中的价值。方法回顾性分析2019年9月-2020年5月该院收治的90例RP患儿的临床资料,先后使用上述3种方法收集标本,然后进行细菌培养比较。结果痰培养、BAL和经支气管镜防污染采样刷检3种取材方法的细菌培养阳性率分别为14.4%(13/90)、32.2%(29/90)和60.0%(54/90),3组比较,差异有统计学意义(􀱽2=41.41,P<0.01),痰培养阳性率与BAL比较,差异有统计学意义(P<0.01),经支气管镜防污染采样刷检阳性率与痰培养和BAL阳性率比较,差异均有统计学意义(P<0.01)。结论经支气管镜防污染采样刷检细菌培养结果的准确性和敏感性均明显高于常规的痰培养与BAL,对儿童RP病原体的正确诊断和抗生素的合理选择有很好的指导作用,值得临床推广应用。

Objective The sensitivity and accuracy of bacterial culture were compared among three sampling methods: sputum culture, bronchoalveolar lavage(BAL) and anti-pollution sampling and brushing by bronchoscope to explore the clinical value of anti-pollution sampling and brushing by bronchoscope in the etiological diagnosis of refractory pneumonia in children. Methods The clinical data of 90 children with refractory pneumonia from September 2019 to May 2020 were retrospectively analyzed, the above three methods were successively used to collect specimens, and Bacterial cultures were then compared. Results The positive rates of bacterial culture in the three methods of sputum culture, BAL and anti-pollution sampling and brushing by bronchoscope were 14.4%(13/90), 32.2%(29/90) and 60.0%(54/90). The difference between the three groups was statistically significant(χ2= 41.41, P < 0.01). The positive rate of bacterial culture in sputum samples was statistically different from that of BAL(P < 0.01). The positive rate of bacterial culture in anti-pollution sampling and brushing by bronchoscope was statistically different from sputum culture and BAL(P < 0.01). Conclusion The accuracy and sensitivity of the bacterial culture results of bronchoscopy protected specimen brush are significantly higher than that of conventional sputum culture and BAL, which has a good guidance for the correct diagnosis of children with refractory pneumonia pathogens and the rational choice of antibiotics. The significance is worthy of clinical application.