纤维支气管镜联合快速现场评价对肺部感染的诊断价值

Diagnostic value of fiberbronchoscopy combined with rapid on-site evaluation in pulmonary infection

目的探讨纤维支气管镜联合快速现场评价(ROSE)技术对肺部感染的诊断价值。方法选取某院2017年7月—2018年6月(纤支镜组:采用常规纤维支气管镜检查)和2018年7月—2019年6月(纤支镜+ROSE组:采用纤维支气管镜联合ROSE检查)就诊的肺部感染患者,比较两组患者的检查结果,并将随访6个月的确诊结果分别与两组现场检查结果比较,计算Kappa值并绘制受试者工作特征(ROC)曲线,评价诊断效果。结果共纳入438例患者,其中纤支镜组207例,纤支镜+ROSE组231例。与纤支镜组相比,纤支镜+ROSE组的首次检查时间较长(χ^(2)=1.965,P<0.001),但首次检查未明确诊断需选择二次检查的患者比例更低(χ^(2)=24.533,P<0.001),纤支镜+ROSE组较纤支镜组具有更高的诊断效能(Kappa:0.411 VS 0.164;AUC:0.904 VS 0.759)。结论ROSE技术可提供明确的细胞学背景,利于肺部感染的病原学分类,与单纯纤维支气管镜技术相比,纤维支气管镜联合ROSE技术具有更高的诊断效能,可有效减少二次检查,值得在临床上广泛推广。

Objective To evaluate the diagnostic value of fiberbronchoscopy combined with rapid on-site evaluation(ROSE)in pulmonary infection.Methods Patients with pulmonary infection in a hospital from July 2017 to June 2018(fiberbronchoscopy group:performed routine fiberbronchoscopy)and from July 2018 to June 2019(fiberbronchoscopy+ROSE group:performed fiberbronchoscopy combined with ROSE examination)were selected,the examination results of two groups of patients were compared,confirmed diagnostic results of 6-month follow-up were compared with on-site evaluation results of two groups,Kappa value was calculated and receiver operating characteristic(ROC)curve were plotted to evaluate diagnostic efficacy.Results A total of 438 patients were enrolled,207 were in fiberbronchoscopy group and 231 in fiberbronchoscopy+ROSE group.Compared with fiberbronchoscopy group,the time of the first examination was longer in fibrobronchoscope+ROSE group(χ^(2)=1.965,P<0.001),but the proportion of patients who needed to choose the second examination due to the unclear diagnosis in the first examination was lower(χ^(2)=24.533,P<0.001),diagnostic efficiency of fiberbronchoscopy+ROSE group was higher than that of fiberbronchoscopy group(Kappa:0.411 vs 0.164;AUC:0.904 vs 0.759).Conclusion ROSE technique can provide a clear cytological background and help to facilitate the etiological classification of pulmonary infection,compared with simple fiberbronchoscopy,the combination of fiberbronchoscopy and ROSE technique has higher diagnostic efficacy and can effectively reduce the number of second examination,it is worthy of clinical application.