超声鞘引导冷冻肺活检在不吸收肺炎中的应用价值

The application of transbronchial lung cryobiopsy guided by endobronchial ultrasound sheath in diagnosis of nonresolving pneumonias

目的探讨径向超声鞘引导冷冻肺活检(EBUS-GS-TBCB)在不吸收肺炎诊断中的应用价值。方法选取2019年3月至2020年7月大连市中心医院诊治的不吸收肺炎60例,将患者按随机数字表法分为EBUS-GS-TBCB组(31例)和径向超声鞘引导活检钳肺活检(EBUS-GS-TBLB)组(29例)。结果 EBUS-GS-TBCB组对不吸收肺炎诊断率明显高于EBUS-GS-TBLB组[87.10%(27/31)比65.52%(19/29)],两组比较差异有统计学意义(χ^(2) = 3.90,P = 0.048)。两组诊断不吸收肺炎的灵敏度、特异度、准确率、阳性预测值和阴性预测值比较差异无统计学意义(P>0.05)。EBUS-GS-TBCB组和EBUS-GS-TBLB组病变与胸膜距离、气胸发生率和出血发生率比较差异无统计学意义[(27.42 ± 2.88) mm比(27.01 ± 2.37) mm、6.45%(2/31)比3.45%(1/29)和22.58%(7/31)比13.79%(4/29),P>0.05]。导致肺炎不吸收的病因中感染因素占21.67%(13/60),非感染因素占66.67%(40/60),原因不确定占11.67%(7/60)。结论 EBUS-GS-TBCB对不吸收肺炎的诊断率明显高于EBUS-GS-TBLB,出血和气胸等并发症未明显增多。

Objective To explore the application of transbronchial lung cryobiopsy guided by endobronchial ultrasound sheath(EBUS-GS-TBCB)in diagnosis of nonresolving pneumonias.Methods Sixty patients with nonresolving pneumonias from March 2019 to July 2020 in Dalian Municipal Central Hospital were selected.The patients were divided into EBUS-GS-TBCB group(31 cases)and transbronchial forcep lung biopsy guided by endobronchial ultrasound sheath(EBUS-GS-TBLB)group(29 cases)by random digits table method.Results The diagnostic rate of nonresolving pneumonias in EBUS-GS-TBCB group was significantly higher than that in EBUS-GS-TBLB group:87.10%(27/31)vs.65.52%(19/29),and there was statistical difference(χ^(2)=3.90,P=0.048).There were no statistical difference in sensitivity,specificity,accuracy,positive predictive value and negative predictive value between 2 groups(P>0.05).There were no statistical difference inthe shortest distance from lesions to pleura,incidence of pneumothorax and incidence of bleeding between EBUS-GS-TBCB group and EBUS-GS-TBLB group:(27.42±2.88)mm vs.(27.01±2.37)mm,6.45%(2/31)vs.3.45%(1/29)and 22.58%(7/31)vs.13.79%(4/29),P>0.05.Among the causes of nonresolving pneumonias,infectious factors accounted for 21.67%(13/60),non infectious factors accounted for 66.67%(40/60),and uncertain causes accounted for 11.67%(7/60).Conclusions The diagnostic rate of EBUS-GS-TBCB in nonresolving pneumonias is significantly higher than EBUS-GS-TBLB,and the complications such as bleeding and pneumothorax do not increase significantly.