支气管镜活检联合现场细胞学检测在肺结核初筛的效能研究

Efficacy of bronchoscopic biopsy combined with on-the-spot cytological detection in primary screening of pulmonary tuberculosis

目的:探讨支气管镜活检联合现场细胞学检测在肺结核初筛的效能。方法:选取医院收治的60例疑似肺结核患者,根据不同检测方法将其分为观察组(33例)和对照组(27例),观察组给予支气管镜活检联合现场细胞学检测,对照组给予支气管镜活检,以病理诊断结果为“金标准”,分析两组诊断肺结核的灵敏度、特异度和准确率,对比两组检测中的病灶大小、病灶距胸膜距离、部位及出血量,以及操作时间、穿刺次数和并发症发生率。结果:观察组未明确诊断率明显低于对照组,差异有统计学意义(x^(2)=4.364,P<0.05);观察组诊断肺结核的灵敏度、特异度和准确率分别为81.82%、72.73%和78.79%,与对照组比较差异无统计学意义;观察组和对照组诊断受试者工作特征(ROC)曲线下面积(AUC)分别为0.773和0.675,两组比较差异有统计学意义(x^(2)=5.543,P<0.05);两组病灶大小、病灶距胸膜距离、部位及出血量比较差异无统计学意义;观察组操作时间及穿刺次数明显少于对照组,差异有统计学意义(t=-10.969,t=-8.239;P<0.05);观察组诊断费用明显少于对照组,差异有统计学意义(t=-10.128,P<0.05);两组并发症发生率比较差异无统计学意义。结论:支气管镜活检联合现场细胞学检测在肺结核诊断中有较好的价值,并具有操作简便、费用低等优点。

Objective:To investigate the efficacy of bronchoscopic biopsy combined with on-site cytological detection in primary screening of pulmonary tuberculosis.Methods:60 patients with suspected pulmonary tuberculosis who admitted to hospital were selected,and they were divided into observation group(n=33)and control group(n=27)according to different detection methods.The observation group underwent bronchoscopic biopsy combined with onsite cytological detection,and the control group underwent bronchoscopic biopsy.The pathological result was used as golden standard to analyze sensitivity,specificity and accuracy of two kinds of methods in diagnosing pulmonary tuberculosis.And then,the lesion size,the distance from lesion to pleura,the location of lesion,the amount of bleeding,the operational time,the times of puncture and the incidence of complication in detection between two groups were further compared.Results:The undetermined diagnosis rate of observation group was significantly lower than that of control group(x^(2)=4.364,P0.05).The area under curve(AUCs)of receiver operating characteristics(ROC)curve of observation group and control group were 0.773 and 0.675,respectively(x^(2)=5.543,P<0.05).There were no significant difference in lesion size,distance from lesion to pleura,location and amount of bleeding between two groups.The operation time and the times of puncture of observation group were significantly less than those of control group(t=-10.969,t=-8.239,P<0.05).The diagnostic cost of observation group was significantly less than that of control group(t=-10.128,P<0.05).There was no significant difference in the incidence of complications between two groups.Conclusion:Bronchoscopic biopsy combined with on-the-spot cytological detection has a favorable value in the diagnosis of pulmonary tuberculosis,which has the advantages of simple operation and low cost.