涂片与培养方法检测痰液和肺泡灌洗液中抗酸菌诊断肺结核的管理研究

Detection of acid-fast bacteria in sputum and alveolar lavage fluid using smear and culture methods for diagnosis of pulmonary tuberculosis

目的评价痰液和肺泡灌洗液联合抗酸菌检测的临床应用价值,为肺结核临床诊疗决策提供参考。方法以在同一周内并行痰液涂片染色查找抗酸菌和/或分枝杆菌培养检查的可疑肺结核患者为研究对象,从医院LIS系统中收集、整理2021年1月—7月的相关检测数据,分析4种检测结果的同一性与差异性。结果①在272例患者中,痰涂片、肺泡灌洗液涂片、痰培养、肺泡灌洗液培养(以下分别称为“A”“B”“C”“D”)的阳性检出率分别为14.71%(40/272)、19.49%(53/272)、25.00%(67/268)和31.90%(74/232),4种检测作为平行试验的阳性率为37.50%(102/272);②A^(+)C^(+)、A^(-)C^(+)、A^(+)C^(-)、A^(-)C^(-)、A^(-)C N(上标中的“+”“-”“N”分别代表“阳性”“阴性”“未检测”,下同)和B^(+)D^(+)、B^(-)D^(+)、B^(+)D^(-)、B^(-)D^(-)、B^(-)D^(N)结果组合分别占14.71%(40/272)、13.97%(38/272)、0、69.85%(190/272)、1.47%(4/272)和19.12%(52/272)、8.82%(24/272)、0.37%(1/272)、56.99%(155/272)、14.71%(40/272);③A^(+)B^(+)、A^(+)B^(-)、A^(-)B^(+)、A^(-)B^(-)和A^(+)D^(+)、A^(+)D^(-)、A^(+)D^(N)、A^(-)D^(+)、A^(-)D^(-)、A^(-)D^(N)、A^(N)D^(+)、A^(N)D^(-)、A^(N)D^(N)结果组合分别占14.71%(40/272)、0、4.78%(13/272)、80.51%(219/272)和19.12%(52/272)、5.51%(15/272)、4.04(11/272)、8.09%(22/272)、51.74%(140/272)、10.29%(28/272)、0.74%(2/272)、0.37%(1/272)、0.37%(1/272)。结论较通常应用痰液检测抗酸菌而言,行肺泡灌洗液抗酸菌检测可以大幅提高肺结核病原学确诊率,值得临床大力推广应用。

Objective This study aims to assess the clinical value of sputum and bronchoalveolar lavage fluid examination combined with acid-fast bacilli detection to provide a reference for the diagnosis and treatment of pulmonary tuberculosis.Methods We collected and analyzed relevant test data from patients who underwent smear and/or isolation of sputum and bronchoalveolar lavage fluid for acid-fast bacilli or Mycobacterium detection within the same week from January 2021 to July 2021.The test results’similarities and differences were analyzed.Results Of the 272 patients,the positive rates of sputum smear,alveolar lavage fluid smear,sputum isolation,alveolar lavage fluid isolation(hereinafter referred to as“A”“B”“C”and“D”)were 14.71%(40/272),19.49%(53/272),25.00%(67/268)and 31.90%(74/232),respectively.The positive rate of the four tests as parallel tests was 37.50%(102/272).The result modes of A^(+)C^(+),A^(-)C^(+),A^(+)C^(-),A^(-)C^(-)and A^(-)CN(the“+”“-”and“N”in the superscript stood for“positive”“negative”and“undetected”)accounted for 14.71%(40/272),13.97%(38/272),0,69.85%(190/272),1.47%(4/272)respectively,and the result modes of B^(+)D^(+),B^(-)D^(+),B^(+)D^(-),B^(-)D^(-)and B^(-)D^(N)accounted for 19.12%(52/272),8.82%(24/272),0.37%(1/272),56.99%(155/272),14.71%(40/272).The percentages of these result modes of A^(+)B^(+),A^(+)B^(-),A^(-)B^(+)and A^(-)B^(-)were 14.71%(40/272),0,4.78%(13/272),80.51%(219/272),respectively.The percentages of these result modes of A^(+)D^(+),A^(+)D^(-),A^(+)D^(N),A^(-)D^(+),A^(-)D^(-),A^(-)D^(N),A^(N)D^(+),A^(N)D^(-)and A^(N)D^(N)were 19.12%(52/272),5.51%(15/272),4.04(11/272),8.09%(22/272),51.74%(140/272),10.29%(28/272),0.74%(2/272),0.37%(1/272),and 0.37%(1/272),respectively.Conclusion Compared with more common sputum testing,for acid-fast bacteria,performing bronchoalveolar lavage fluid testing for acid-fast bacteria in alveolar lavage fluid can significantly improve etiological diagnostic performance for tuberculosis,which is worth promoting extensively in clinical practice.