聚合酶链反应对菌阳肺结核治疗的监测

目的探讨痰菌阳性肺结核患者在治疗期及停药２年内痰结核分支杆菌及其ＤＮＡ阴转情况与复发的关系以及聚合酶链反应（ＰＣＲ）对菌阳肺结核患者治疗的监测价值。方法用ＰＣＲ技术、涂片及培养法对８７例菌阳肺结核于治疗期每月检测１次，停药期继续随访２年。结果痰结核分支杆菌ＰＣＲ转阴时间通常比涂片和培养迟１～３个月，痰含菌量越多，ＰＣＲ持续阳性时间越长。８７例中１０例（１１％）ＰＣＲ持续阳性１年以上，其中３例（３０％）分别于停药后８、１２、１６个月时复发，１例ＰＣＲ已转阴病例于１８个月时复发。此４例均有痰菌复阳，胸片示病灶增多而再次接受治疗。结论ＰＣＲ用于临床疗效观察比涂片、培养实用，对估计有可能复发的病例有一定帮助。     

短程化疗结束后痰菌阴性肺结核患者复发情况随访观察

目的：评价WHO西太区结核病控制示范区项目（江苏）的控制效果，分析患的有关复发因素。方法：对西太区项目发现、登记的涂阳肺结核患，在治愈后的2－3年进行痰结核分支杆菌厚涂片检查，观察细菌学复发情况；对涂阳患治疗前的排菌情况和痰菌转阴时间与复发的关系，进行历史性队列研究。结果：随访观察的1730例治毹涂阳肺结核患，经痰涂片检查，痰菌复阳57例，复发率为3．29％。治疗后第2个月、第3个月和大于3个月转阴的初治涂阳患复发率分别是2．1％、5．3％和8．8％（P＜0．01）。治疗前不同排菌量患的复发率有一定差异，但差异无显性（P＞0．05）。结论：WHO西太区结核病控制示范区项目（江苏）的远期治疗效果是满意的。治疗后第3个月及大于3个月开始痰菌转阴的初治涂阳患复发率明显高于第2个月转阴的患。     

The validity of acid-fast smears of gastric aspirates as an indicator of pulmonary tuberculosis.

SETTING: A tuberculosis referral hospital in Canada. OBJECTIVE: To determine the validity of acid-fast (AFB) smears of gastric aspirates (GA) in the diagnosis of pulmonary tuberculosis, and to assess the prevalence of nontuberculous mycobacteria (NTM) in GA isolates from such patients. DESIGN: A retrospective case review of our experience with AFB smears (Kinyoun) and cultures of GA and sputum over a 3-year period. RESULTS: From 1994 to 1996 inclusive, 1155 GA were performed in 889 patients. Mycobacteria were cultured from 109 (9%) GA. Thirteen of these were positive on smear (sensitivity 19%). All GA that were positive on smear were culture positive for Mycobacterium tuberculosis. There were no false positive smears (specificity 100%). The sensitivity and specificity of the sputum smear were 45% and 99%, respectively. Of the 96 culture positive, smear negative GA, 54 grew M. tuberculosis and 42 grew an NTM. Of 13 patients who had sputum and GA studied coincidentally, and in whom the sputum was both smear and culture positive, the GA culture was positive in 13 and the smear was positive in eight (66%). CONCLUSION: AFB smear of GA is a relatively insensitive but highly specific indicator of pulmonary tuberculosis warranting institution of antituberculosis treatment. Gastric AFB smear positivity appears to reflect a high bacillary burden within the respiratory tract.     

82例初治痰涂片阳性老年肺结核患者的近期临床观察

目的 探讨初治痰涂片阳性老年肺结核患者的疗效、对抗结核药物的耐受性及左氧氟沙星的有效性和安全性。方法 将82例初治痰涂片阳性老年肺结核患者按4：3分为治疗组和对照组进行6个月的临床观察（强化期2个月，巩固期4个月）。治疗组选用可乐必妥，按2HLEV／4HLE方案给药；对照组用吡嗪酰胺，按2HLEZ／4HLE给药。结果 治疗组和对照组2个月痰菌阴转率分别为72．7％和63．3％（P＞0．05），治疗6个月痰菌阴转率分别为88．6％和83．3％（P＞0．05），胸部X线病灶吸收分别为86．4％和86．7％（P＞0．05），空洞闭合率分别为30．0％和24．1％（P＞0．05），药物副反应发生率分别为25．5％和51．4％（P＜0．05）。结论 老年人肺结核治愈率较低，药物副反应发生率高，左氧氟沙星对老年人肺结核安全有效。     

Sputum smear conversion during directly observed treatment for tuberculosis

Setting: Treatment program for tuberculosis in a refugee camp in Thailand.Objectives: To determine the cumulative frequency of conversion of sputum smears examined by direct microscopy by month of treatment and to identify factors predicting failure to convert.Methods: Analysis of conversion based on three sputum smear examinations (performed monthly) in a cohort of patients with sputum smear-positive tuberculosis treated with a directly observed daily regimen containing rifampicin throughout. Nested case-control study of patients failing to convert definitively within four months compared to controls who did convert.Results: Sputum conversion after the 2-month intensive phase was 75.0%, with a range from 61.7% to 90.9% in patients with initially strongly- and weakly-positive smears, respectively. The strongest predictor identified for no definitive conversion within four months of treatment was a positive sputum smear result at the end of the 2-month intensive phase (adjusted relative odds 4.2, 95% confidence interval 1.5–11.4). Of those patients who did not convert, positive smears were an isolated phenomenon in 15, repeatedly in four who definitely converted with a prolongation of treatment, and persistently positive in two requiring a re-treatment regimen.Conclusions: Definitive sputum smear conversion is judged to be slower if a strict program of sputum smear examination is undertaken than under routine program conditions, but positive results late in the course are commonly an isolated phenomenon and possibly of little significance. Sputum smear results at two months strongly predict bacteriologic results beyond three months of treatment, and thus identify cases who might benefit from a prolongation of the intensive phase.     

四种结核分枝杆菌检测方法的临床应用评价

目的评估涂片、培养、PCR和增菌PCR检测结核分枝杆菌临床应用价值。方法对124例临床确诊的肺结核、可疑结核患者和非结核病人痰标本的涂片、培养、PCR和增菌PCR四种方法的检测结果进行比较。结果涂片、培养、PCR和4及7d的增菌PCR检测31例临床确诊的肺结核病人痰标本阳性率分别为22.5%、32.2%、54.8%、64.5%和87.1%;检测59例临床可疑肺结核病人痰标本阳性率分别为13.6%、18.6%、28.8%、37.3%和52.5%。比较四种方法的阳性检测率有显著性差异(P<0.05)。检测34例非结核病人痰标本,涂片、培养均为阴性,而PCR和增菌PCR均有1例假阳性,假阳性率2.9%。比较PCR与增菌PCR对菌阳和菌阴病人的痰标本阳性检测率,有显著性差异(P<0.05),而两种方法的假阳性率相同。结论增菌PCR检测结核分枝杆菌具有很高的敏感性和特异性,可作为结核病的有效辅助诊断方法之一。     

Factors associated with time to sputum smear conversion in active pulmonary tuberculosis.

OBJECTIVE: To ascertain the factors affecting the time between the initiation of treatment and obtaining three negative sputum smears. DESIGN: In a study of 109 patients with pulmonary tuberculosis, the main variable was the period during which the patients had sputum smears once treatment was initiated. Multivariate analysis (multiple linear regression) was performed to document those variables independently associated with time to conversion. RESULTS: The patients had positive smears for a mean of 28.63 days. The most frequent radiographic pattern was cavitary disease (36.7%). HIV co-infection was present in 38.5% of the patients. HIV-infected patients showed a cavitation pattern in only 9.6% vs 52.2% of patients without HIV infection (P < 0.001). The variables that showed a statistically significant and independent relationship with the time to sputum smear conversion were pulmonary radiographic pattern, age and erythrocyte sedimentation rate (ESR). CONCLUSIONS: ESR, age and the presence of cavitary disease seem to be factors associated with a longer time to sputum smear conversion in patients with active pulmonary tuberculosis. However, HIV co-infection is associated with a shorter time to sputum conversion. A key factor is therefore the presence or not of cavitation, independently of HIV infection.     

HIV co-infection, CD4 cell counts and clinical correlates of bacillary density in pulmonary tuberculosis.

BACKGROUND: Sputum microscopy for acid-fast bacilli (AFB) is the commonest diagnostic method for pulmonary tuberculosis (PTB) in developing countries. The method is reported to be less sensitive in human immunodeficiency virus (HIV) positive compared to negative patients. We determined the bacillary density in sputum of smear-positive PTB patients and related it to the patients' HIV status, CD4 cell count, clinical and demographic characteristics. METHODS: Three sputum samples per patient were examined using microscopy before initiating therapy. The AFB density was graded according to World Health Organization recommendations. The smear with the highest density was used. High bacillary density was defined as >10 AFB/field. HIV status and CD4 cell count were determined according to the national guidelines. RESULTS: Of 844 patients, 433 (51.3%) were HIV-positive. High bacillary density was significantly less common among HIV-positive (39.0%) than -negative (75.7%) patients (prevalence ratio 0.52; 95%CI 0.45-0.59, P < 0.0001). Among HIV-positive patients, the proportion of those with high bacillary density increased progressively with CD4 cell counts (P = 0.003). CONCLUSION: HIV is associated with lower AFB concentration in sputum. The AFB density falls with falling CD4 cell count. Microscopy for AFB in sputum may be less sensitive in diagnosing PTB when HIV infection is present, especially in severely immunocompromised patients.     

53例肺结核患者规律治疗中痰菌转阳的临床分析

目的 分析肺结核患者规律治疗过程中痰菌转阳的原因。 方法 回顾性分析53例临床规律治疗过程中痰菌转阳病例。 结果53例病人中,菌阴转阳病例18 例：第2个月转阳的8例（44.4%）,其中原始耐药3例（16.7%）;第3个月转阳的2例（11.1%）;第5个月转阳8例（44.4%）。菌阳病例35例：第3个月转阳的13例（37.1%）;第5个月转阳的12例（34.3%）;第6个月转阳的8例（22.9%）,其中3例病灶恶化（7.7%）,1例由于免疫疾病服用大量激素,且耐药;第8个月及以后转阳的2例（5.7%）。支气管结核、耐药、合并糖尿病、复治是肺结核痰涂片转阳的主要原因。 结论 结核病治疗中要加强痰菌观察,及时发现转阳病例。     

Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients.

OBJECTIVE: To understand the influence of diabetes on the clinical and bacteriological aspects and treatment outcome of pulmonary tuberculosis (PTB) patients. SETTING AND DESIGN: Records of 692 consecutive smear-positive PTB patients admitted to a referral hospital in Riyadh, Saudi Arabia, were reviewed retrospectively. The characteristics of 187 patients with diabetes mellitus (PTB-DM group) were compared to 505 patients without DM (PTB group). RESULTS: In the PTB-DM group, 65.2% of the patients had numerous acid-fast bacilli (AFB) on sputum smear examination compared to 54.1% in the control group (P = 0.008). Among new cases, PTB-DM patients had a lower prevalence of resistance to any anti-tuberculosis drug (6.4% vs. 16.0%, P = 0.007) and achieved higher sputum conversion rates at the end of 3 months of treatment (98.9% vs. 94.7%, P = 0.013). Favourable outcomes (cured/treatment completed), failure, death and default were comparable in both groups (P = 0.7005). CONCLUSIONS: PTB-DM patients have a higher pre-treatment bacillary load, a lower prevalence of anti-tuberculosis drug resistance and achieve slightly higher sputum conversion by the end of 3 months of treatment compared to non-diabetic patients. The association of diabetes does not alter the final treatment outcome among PTB patients.     

TB-SA antibody test for diagnosis and monitoring treatment outcome of sputum smear negative pulmonary tuberculosis patients

The objectives of this study were to evaluate the suitability of the TB-SA antibody test to diagnose tuberculosis in sputum smear negative (SS-) pulmonary tuberculosis (TB) patients and its applicability for monitoring treatment outcomes in these patients. This study was conducted in three counties/districts in Chongqing Municipality, Liaoning Province, China between June 2005 and June 2007. A total of 432 SS suspected pulmonary TB patients were recruited and their blood was collected prior to treatment, at the end of 1 month of treatment, 2 months of treatment and 6 months of treatment (E6MT). The serum samples were analyzed with a TB-SA antibody test kit. Of the 432 SS suspected pulmonary TB patients, serum samples were obtained at all time points in 316 patients and analyzed. The 316 patients were divided into three groups according to sputum smear and sputum culture results and the chest X-ray results before treatment and at E6MT. Ten point four percent were SS-/culture positive (C+), 73.1% were SS-/culture negative (C-) with X-rays abnormalities, and 16.5% were SS-/C- without X-rays abnormalities. The positive rates for TB-SA antibody in the three groups were 57.6, 44.6 and 44.2%, respectively, before treatment, and 18.2, 19.1 and 26.9%, respectively, at E6MT. There was a significant decrease in TB-SA antibody positivity with treatment for all 3 groups. The TB-SA antibody test may be a useful adjunct to diagnose tuberculosis in SS- pulmonary TB patients, and may be useful for monitoring treatment outcomes of SS- pulmonary TB patients.     

母牛分枝杆菌菌苗对复治性肺结核的辅助治疗作用

目的观察母牛分枝杆菌菌苗（微卡）在复治性肺结核治疗中的疗效。方法将146例痰抗酸杆菌（AFB）阳性复治肺结核患者分成微卡治疗组（n：90）和对照组（n=56）疗程各6个月,前者采用复治化疗方案加用微卡治疗,后者仪用复治方案治疗。结果疗程结束时微卡治疗组和对照组痰阴转率分别为85．56％（77／90）、67．86％（38／56）,差异有显著性（P〈0．05）。微卡治疗组和对照组有效率分别为81．11％（73／90）、44．64％（25／56）,两组比较差异有显著性（P〈0．001）。结论微卡能改善难治性肺结核患者的细胞免疫功能,有助于痰菌阴转和病灶吸收,可作为复治性肺结核化疗的辅助药物。     

Effect of cigarette smoking on sputum smear conversion in adults with active pulmonary tuberculosis

Although factors influencing sputum smear conversion in tuberculosis have been studied well, the effect of smoking is largely unknown. Excluding those with incomplete history or drug resistant isolates, 339 patients out of the 526 sputum positive patients registered between 1998 and 2000 were studied. At the end of 2 months, smokers and non-smokers converted with almost the same frequency to a negative sputum status {P=0.065, OR (95%CI) 0.47 (0.21-1.06)}. Although gender or age had no effect on sputum conversion with respect to smoking status, expatriate smokers as a whole showed a significant difference. (P=0.039). On applying logistic regression model, smokers with far advanced radiographic abnormalities (P<0.038) or with 3+ smear status (P=0.011), were found to have a less chance of an early smear conversion. In conclusion smoking did not influence sputum smear conversion in tuberculosis. However, as expatriate smokers and smokers with advanced disease showed a delay in smear conversion, smoking should be discouraged in patients with pulmonary tuberculosis.     

微卡辅助治疗复治涂阳肺结核的临床效果

目的评价微卡（母牛分枝杆菌菌苗）作为免疫调节剂辅助治疗复治涂阳肺结核的疗效。方法将80例复治涂阳肺结核病人随机分为治疗组40例及对照组40例，两组化疗方案相同3SHRZE／6HR，治疗组肌肉注射微卡，每半月1次，共9个月，观察药物不良反应。结果疗程结束时，治疗组痰菌阴转率为92．5％，明显高于对照组77．5％（P〈0．01）；治疗组病灶吸收，空洞关闭率分别为97．5％和91．7％均明显高于对照组85．0％和78．3％（P〈0．01），有统计学意义。结论微卡是一种新型免疫调节剂，可提高复治涂阳肺结核的疗效，值得推广。     

2014—2018年佛山市肺结核患者复发情况及影响因素分析

目的 通过对佛山市肺结核患者复发率及其影响因素的研究,为预防肺结核复发提供科学依据。方法 从《中国疾病预防控制信息系统》子系统《结核病管理信息系统》中,收集2014年1月至2018年12月佛山市报告登记、且治疗结果为治愈或完成疗程的15208例初治肺结核患者病案信息,采用Cox比例风险回归模型对161例复发肺结核患者的一般资料、临床信息、病原学结果及治疗转归等情况进行分析。结果 15208例肺结核患者5年内发现161例(1.06%)复发。1年后的累积复发率为0.40%(61/15208),2年后的累积复发率为0.70%(106/15208),5年后的累积复发率为1.05%(159/15208)。在Cox比例风险回归模型中,本地户籍(HR=1.56,95%CI:1.14~2.14,P=0.005)、诊断时痰涂片阳性(HR=2.92,95%CI:2.10~4.06,P<0.001)、治疗2个月末痰涂片阳性(HR=3.94,95%CI:2.41~6.47,P<0.001)、血尿素氮异常(HR=8.76,95%CI:5.00~15.36,P<0.001)是肺结核复发的独立危险因素。结论 重点加强对本地户籍、诊断时痰涂片阳性、血尿素氮异常的肺结核患者的管理,保证其规范治疗管理质量,同时对这一类肺结核复发的高危人群开展有针对性的干预措施,可减少肺结核复发。     

广州市初治涂阳肺结核患者治疗2个月末痰涂片不阴转原因探讨

目的　探讨广州市初治涂阳肺结核治疗2个月末痰涂不阴转的原因,为提高化疗效果提供参考资料。方法 对项目实施初期收治的初治涂阳肺结核病例231例,根据治疗2个月末痰涂片结果分为阴转组与未阴转组,回顾分析比较2组的临床资料。结果 单因素分析显示阴转组与未阴转组之间就诊延误、病灶范围≥2个肺野、肺部含有空洞、合并有糖尿病、痰涂片≥2+等变量有显著性差异(P<0.01);以治疗2个月末痰涂片不阴转作为因变量进行Logistic回归分析,结果显示影响因素是就诊延误、肺部含有空洞、合并有糖尿病等。结论 结核病防治工作需加强健康教育,重视对肺部含有空洞的病人的治疗、特别是重视合并有糖尿病病人的治疗。     

Factors influencing time to smear conversion in patients with smear-positive pulmonary tuberculosis

Background and objective:   Persistent smear-positivity in patients with pulmonary tuberculosis has been shown to predict an unfavourable outcome. This study was conducted to identify the factors influencing time to sputum smear conversion.
Methods:   From July 2003 to June 2007, all patients with smear-positive and culture-confirmed pulmonary tuberculosis, who had attended a medical centre and a local teaching hospital, were identified. Factors that might have influenced time to smear conversion were investigated using time-to-event analysis.
Results:   Altogether 305 patients (mean age: 58.6 years) were studied. Diabetes mellitus was the most common underlying comorbidity. Eight patients (2.6%) had AIDS. After 2 months of treatment, 34 (11.1%) patients remained smear- and culture-positive. Cox proportional hazard regression analysis indicated that the presence of a cavity on CXR, smear grading and the first 2-month treatment regimen were independent factors influencing the time to sputum smear conversion. Among patients who had received isoniazid in the first 2 months of treatment, the time to sputum smear conversion in the 24 patients whose isolate showed isoniazid resistance was not different from that in the 236 patients whose isolate was isoniazid-susceptible (hazard ratio 1.061; 95% CI: 0.697–1.616).
Conclusions:   This analysis revealed that 11.1% of tuberculosis patients remained smear-positive after 2 months of treatment. Patients with cavitation, higher smear grading and those who had not used isoniazid, rifampicin, ethambutol and pyrazinamide continuously in the initial treatment phase had a longer time to sputum smear conversion.     

分子药物敏感性试验对复治涂阳肺结核患者化疗的指导及效果分析

目的 评价分子药物敏感性试验(简称“药敏试验”)对复治涂阳肺结核患者化疗的指导及效果。方法 采用前瞻性随机对照的方法,选取2016年3月至2020年1月上海市肺科医院诊治的400例复治涂阳肺结核患者作为研究对象,收集患者的痰液或支气管肺泡灌洗液行分枝杆菌培养,培养阳性且鉴定为MTB的分离株采用微孔板法进行表型药敏试验;按就诊时间顺序依随机数字表法对其中200例患者的同一份标本采用PCR-反向点杂交法进行分子药敏试验,检测异烟肼和利福平耐药相关基因。微孔板法结果回报前,PCR-反向点杂交法检测为异烟肼和(或)利福平耐药的患者予异烟肼和(或)利福平耐药化疗方案,其余患者予异烟肼、利福平敏感复治化疗方案;微孔板法结果回报后,以微孔板法结果为标准调整化疗方案。比较微孔板法确诊的利福平耐药患者中行PCR-反向点杂交法者与未行PCR-反向点杂交法者在微孔板法结果回报时的痰涂片抗酸杆菌阴转率和痰涂片阳性标本荷菌量,以及在应用耐药方案治疗3、6、9、12个月末的痰菌阴转率。结果 在微孔板法确诊的利福平耐药患者中,行PCR-反向点杂交法与未行PCR-反向点杂交法的患者在微孔板法结果回报时的痰涂片抗酸杆菌阴转率分别为18.9%(10/53)和5.9%(3/51),差异有统计学意义(χ²=4.007,P=0.045);行PCR-反向点杂交法患者痰涂片阳性标本抗酸杆菌分级计数“+、++、+++、++++”分别占48.8%(21/43)、25.6%(11/43)、16.3%(7/43)、9.3%(4/43),未行PCR-反向点杂交法患者分级计数分别占16.7%(8/48)、35.4%(17/48)、33.3%(16/48)、14.6%(7/48),差异有统计学意义(χ²=11.212,P=0.011),前者痰标本荷菌量更少。行PCR-反向点杂交法的患者治疗3、6、9、12个月末的痰菌阴转率分别为64.0%(32/50)、84.8%(39/46)、82.9%(34/41)、84.2%(32/38),高于未行PCR-反向点杂交法的患者治疗3、6、9、12个月末的痰菌阴转率[分别为58.8%(30/51)、81.0%(34/42)、81.6%(31/38)、81.6%(31/38)],差异均无统计学意义(χ²=0.285,P=0.593;χ²=0.593,P=0.218;χ²=0.025,P=0.874;χ²=0.093,P=0.761)。结论 复治涂阳肺结核患者中根据PCR-反向点杂交法制定化疗方案的利福平耐药患者能在时间上更早获得痰涂片抗酸杆菌阴转率的上升和痰涂片阳性标本荷菌量的下降。     

2018—2020年深圳市龙华区某综合医院呼吸科加强住院患者结核病病原学检查的效果分析

目的: 分析2018—2020年深圳市龙华区某综合医院呼吸科住院的非已知肺结核及疑似肺结核患者中病原学阳性肺结核患者发现的情况,探索在呼吸科住院患者中进行肺结核早期发现的模式。 方法: 2018年1月至2020年12月,龙华区某综合医院设置留痰室,并配备专职留痰宣教人员,对呼吸科住院的非已知肺结核及疑似肺结核患者中有肺结核可疑症状或临床不能排除肺结核的住院患者(342例)采集痰液(或由医务人员采集支气管肺泡灌洗液或胸腔积液),同时进行涂片、培养、GeneXpert MTB/RIF(简称“GeneXpert”)检测,以发现其中病原学阳性的肺结核患者,分析不同检验策略在病原学阳性患者发现中的价值。 结果: 342例患者中,病原学阳性73例,病原学阳性率为21.3%。单一检测方法中,涂片法检出阳性患者24例(32.9%,24/73),培养法检出阳性患者52例(71.2%,52/73),GeneXpert法检出阳性患者54例(74.0%,54/73);检测方法组合中,涂片+培养检查发现阳性患者53例(72.6%,53/73),涂片+GeneXpert检查发现阳性患者58例(79.5%,58/73),培养+GeneXpert检查发现阳性患者73例(100.0%,73/73)。2020年纳入患者的病原学阳性率最高(27.7%,38/137),其次为2018年(20.6%,20/97),2019年最低(13.9%,15/108),差异有统计学意义(χ²=6.941,P=0.031)。结论: 综合医院呼吸科住院患者中,除已知肺结核及胸部影像学检查提示肺结核患者外,仍存在病原学阳性肺结核患者。建议综合医院与当地有检测能力的机构合作,在肺结核诊断性治疗前留痰送检,以实现病原学阳性肺结核患者发现关口的前移。     

支气管镜检查对老年COPD合并肺结核患者的诊断价值

目的观察支气管镜检查在老年COPD合并肺结核患者诊断中的应用价值。方法分析142例老年COPD合并肺结核患者的临床资料,收集患者的痰涂片查抗酸杆菌结果,以及经支气管镜取支气管分泌物刷检涂片、支气管肺泡灌洗液（BALF）查抗酸杆菌、活检病理等检查结果,观察支气管镜检查对此类患者的诊断价值。结果老年COPD合并肺结核患者经支气管镜取支气管分泌物刷检涂片、BALF涂片、活检病理阳性率分别为44．4％,51．4％和60．6％,三种方法联合阳性率为100％,均显著高于痰涂片的阳性率21．8％（P〈0．05）。结论经支气管镜刷检、BALF涂片联合活检可提高老年COPD合并肺结核患者的阳性诊断率。