CT引导经皮穿刺肺活检诊断肺感染性疾病的临床意义

Clinical significance of CT-guided percutaneous lung biopsy in the diagnosis of pulmonary infectious diseases

目的 探讨CT引导经皮穿刺肺活检(CT-GPLB)诊断肺感染性疾病病原体的临床意义。方法 回顾分析2018年3月—2022年8月109例临床怀疑肺感染性疾病患者CT-GPLB病原学诊断结果,并与痰、血、支气管镜常规病原学检查诊断结果比较。结果 109例肺感染性疾病患者中,47例(43.1%)明确病原体,其中真菌24例(其中1例与革兰阴性杆菌混合感染),细菌9例,结核分枝杆菌12例,病毒1例,快速生长型偶发分枝杆菌1例。CT-GPLB病原学诊断率42.2%,另1例痰涂片抗酸染色阳性但其他检查方法阴性。CT-GPLB组织培养阳性率21.1%,病理学阳性率28.4%,肺组织涂片阳性率7.3%。CT-GPLB肺组织病原体总诊断率42.2%(46/109)高于痰标本检查4.1%(3/73)、血标本检查3.1%(1/32)及支气管肺泡灌洗液检查9.8%(8/82)。CT-GPLB组织培养阳性率21.1%(23/109)高于痰培养阳性诊断率2.7%(2/73)和支气管肺泡灌洗液培养阳性诊断率7.3%(6/82)。结论 CT-GPLB组织检查对明确肺部感染性疾病的病原体具有较高的临床价值,诊断率高于常规病原学检查方法。

Objective To explore the clinical significance of CT-guided percutaneous lung biopsy(CT-GPLB)in the diagnosis of pulmonary infectious diseases(PIDs).Methods CT-GPLB pathogenic diagnostic results of 109 patients with clinically suspected PIDs from March 2018 to August 2022 were retrospectively analyzed and compared with conventional pathogenic diagnostic results such as sputum,blood,and bronchoscopy.Results Among 109 cases of PIDs,47 cases(43.1%)had identified pathogens.Among them,there were 24 cases of fungal infections(including 1 case of mixed infection with Gram-negative bacillus),9 cases of bacterial infections,12 cases of Mycobacterium tuberculosis infections,1 case of viral infection,and 1 case of fast-growing Mycobacterium fortuitum infection.The pathogenic diagnosis rate of CT-GPLB was 42.2%,with one case showing positive acid-fast staining in sputum smear but negative in other examinations.The positive rates of CT-GPLB tissue culture,pathology exa-mination,and lung tissue smear were 21.1%,28.4%,and 7.3%,respectively.The overall pathogenic diagnostic rate of CT-GPLB lung tissue was 42.2%(46/109),which was higher than that of sputum specimen examination(4.1%[3/73]),blood examination(3.1%[1/32])and bronchoalveolar lavage fluid(9.8%[8/82]).The positive rate of CT-GPLB tissue culture was 21.1%(23/109),which was higher than that of sputum culture(2.7%[2/73])and bronchoalveolar lavage fluid culture(7.3%[6/82]).Conclusion CT-GPLB tissue examination is of high clinical value in identifying the pathogens of PIDs,with a higher diagnostic rate compared to conventional pathogenic examination methods.