涂阴肺结核患者支气管肺泡灌洗部位CT表现对灌洗结果影响分析

The influence of CT findings of bronchoalveolar lavage site on lavage results in smear negative pulmonary tuberculosis patients

目的 探讨涂阴肺结核患者支气管肺泡灌洗部位CT征象对支气管肺泡灌洗液(BALF)涂片、培养和Xpert结果的影响。方法 选取528例涂阴肺结核患者支气管肺泡灌洗部位CT征象与BALF涂片、培养及Xpert结果间的关系进行分析。结果 BALF涂片、培养和Xpert的阳性率分别为9.66%、32.39%、58.33%。其中以支气管扩张伴管壁增厚、支气管狭窄、充气支气管征及引流支气管征CT征象所在肺叶/段BALF涂片、培养和Xpert阳性率均高于阴性率,差异有统计学意义(P<0.05)。以空洞、磨玻璃影及树芽征所在部位BALF获得Xpert和培养阳性与阴性结果差异有统计学意义(P<0.05)。而以肿块、单纯支气管扩张、支气管闭塞三种CT征象的BALF获得三种结果阳性率与阴性率差异无统计学意义(P>0.05)。多因素回归分析显示支气管扩张伴管壁增厚、支气管狭窄及充气支气管征是获得三种灌洗结果阳性的独立预测因素(P<0.05)。结论 涂阴肺结核患者选择支气管异常改变、空洞、磨玻璃影及树芽征所在的部位进行支气管肺泡灌洗可提高灌洗结果阳性率。

Objective To investigate the effect of CT signs of bronchoalveolar lavage site on bronchoalveolar lavage fluid(BALF)smear,culture,and Xpert results in patients with smear negative pulmonary tuberculosis.Methods A retrospective analysis was conducted on the relationship between CT features of bronchoalveolar lavage site and BALF smear,culture,and Xpert results in 528 patients with smear negative pulmonary tuberculosis admitted to our hospital from.Results The positive rates of BALF smear,culture,and Xpert were 9.66%,32.39%,and 58.33%,respectively.Among them,the positive rates of BALF smear,culture,and Xpert in the lobe/segment of the lung where CT signs of bronchiectasis accompanied by thickening of the tube wall,bronchial stenosis,inflation bronchial sign,and drainage bronchial sign were higher than the negative rates,with statistical significance(P<0.05).There was a statistically significant difference in Xpert and culture positive and negative results obtained from BALF at the location of cavities,ground glass shadows,and tree bud signs(P<0.05).However,there was no statistically significant difference in the positive and negative rates of BALF results obtained from three types of CT signs:mass,simple bronchiectasis,and bronchial occlusion(P>0.05).Multivariate regression analysis showed that bronchiectasis accompanied by wall thickening,bronchial stenosis,and inflatable bronchogram were independent predictive factors for obtaining three positive lavage results(P<0.05).Conclusion Choosing the location of bronchial abnormalities,cavities,ground glass shadows,and tree bud signs for bronchoalveolar lavage in patients with smear negative pulmonary tuberculosis can improve the positive rate of lavage results.