纤支镜下肺活检对肺结核诊断意义

目的：探讨纤支镜肺活检对肺结核早期诊断价值及临床价值。方法收集2013年1月~10月就诊我院呼吸科拟诊肺结核患者,结合临床及影像学,分别行痰查抗酸杆菌检测、PPD实验和结核蛋白芯片检测和纤支镜下刷片、灌洗和活检。结果纤支镜下可以直观看到支气管浸润情况,PPD、结核蛋白芯片检测机纤支镜肺活检阳性率分别为42.3%、46.2%、80.8%。纤维支气管镜肺活检肺结核阳性率显著高于痰检和PPD实验及结合蛋白芯片检测。痰查抗酸杆菌纤支镜激惹后阳性率34.6%明显高于纤支镜前15.4%。结论纤支镜术特别是肺活检可以显著提高患者肺结核的诊断率及结核杆菌的检出率,有助于早期明确结核诊断。     

中、晚期肾结核40例临床分析

目的探讨中晚期肾结核的临床表现特征及其有效治疗方法。方法对40例中晚期肾结核患者的临床资料进行回顾性分析。对所有患者进行尿常规、红细胞沉降率、尿抗酸杆菌、尿结核杆菌-PCR（Tb—PCR）、B超、静脉尿路造影（IVU）、CT等检查，8例患者行药物治疗，32例患者行手术治疗。结果临床表现为腰痛18例（45％），膀胱刺激症24例（60％），血尿28例（70％）。尿常规检查异常38例（95％），红细胞沉降率异常升高36例（90％），尿抗酸杆菌阳性11例（27．5％），尿结核杆菌-PCR（Tb—PCR）阳性18例（45％）。B超检查肾积水、肾结石或／和肾结构异常40例（100％）；静脉尿路造影（IVU）确诊肾结核23例（57．5％），患肾不显影17例（42．5％）；CT确诊肾结核31例（77．5％）。肾结核合并膀胱结核16例，肺结核5例，附睾结核8例。8例患者药物治疗治愈，32例患者手术后经病理确诊为肾结核。结论中晚期肾结核的临床表现多不典型，其诊断应在结合临床表现的前提下以实验室检查与影像学诊断为主。尿沉渣染色查抗酸杆菌仍重要，尿Tb-PCR检查是术前确诊肾结核的主要手段．IVU和B超可作为泌尿系结核诊断首选的影像学检查，治疗仍以手术切除肾脏为主，应尽可能切除患侧全程输尿管。     

荧光定量PCR检测病理组织中结核分枝杆菌的临床价值

目的探讨应用荧光定量PCR（FQ-PCR）技术在病理组织中检测结核分枝杆菌DNA（TB-DNA）的临床应用价值。方法对196例临床诊断结核的穿刺病理活检标本进行石蜡包埋切片,采用实时荧光定量PCR技术检测TB．DNA,并行抗酸染色及组织病理学检查,对三种检测与临床诊断符合率进行比较。结果在196例临床诊断结核的石蜡包埋组织中,荧光定量PCR检测阳性136例,阳性率为69．39％,抗酸染色检测阳性69例,阳性率为35．20％,组织病理学检查阳性102例,阳性率为52．04％,荧光定量PCR检测阳性率最高。结论荧光定量PCR技术简便、快捷,敏感性强、特异性高,可作为结核病分子病理诊断的重要检测方法,具有较高的临床应用价值。     

结核性淋巴结炎的组织细胞反应性增性变型

应用结核杆菌ＤＮＡ１２３ｂｐ特异性序列片段为靶序列的多聚酶链反应（Ｍ．ＴＢ－ＰＣＲ）技术，ＢＣＧ免疫组化（ＢＣＧ－ＩＨＣ）技术和抗酸染色（ＡＦ）方法，对３８例呈现组织细胞反应性增生－碎屑样坏死－嗜中性白细胞渗出病变的淋巴结石蜡包埋组织进行了分支杆菌／结核杆菌的回顾性检测。三种方法的综合阳性率为５２．６％（２０／３８例）。ＡＦ，ＢＣＧ－ＩＨＣ和Ｍ．ＴＢ－ＰＣＲ物各自性率分别为０．８％，２６．３％和５     

结核分枝杆菌多抗原蛋白芯片对儿童结核病的诊断价值

目的探讨结核分枝杆菌（MTB）多抗原蛋白芯片对儿童结核病的诊断价值。方法选取2005年4月至2006年4月在首都医科大学附属北京儿童医院诊断为结核病的住院患儿作为结核病组。选取同期住院，患感染性疾病，同时除外结核病的患儿作为非结核病组；选取体检纯化蛋白衍生物（PPD）试验阳性，既往无结核病史，无明显结核中毒症状，胸部影像学及腹部B超检查未见结核病灶的儿童作为结核感染组；选取同期行健康体检，卡疤试验阳性，无基础疾病，无结核接触史的儿童为健康对照组。各组留取血清标本。计算结核病组PPD试验阳性率及细菌学检查阳性率。应用MTB多抗原蛋白芯片同时检测标本中脂阿拉伯甘露糖（LAM）、相对分子质量16000和38000蛋白IgG抗体，通过蛋白芯片阅读仪判断结果，其中任意1种或1种以上抗体检测阳性，即判为蛋白芯片检测阳性。分别计算各组抗体检测阳性率，并计算该方法检测儿童结核病的灵敏度、特异度、阳性预测值和阴性预测值等指标。应用Logistic回归及，检验分析蛋白芯片检测阳性率与患儿年龄、病程、抗结核治疗时间、激素使用以及结核病类型的关系。结果研究期间共纳入结核病组79例，非结核病组33例，结核感染组15例，健康对照组30例。蛋白芯片检测结核病组的阳性率为34．2％（27／79），低于PPD试验阳性率（84．8％，67／79），高于细菌学检查阳性率（12．7％，10／79）。在非结核病组阳性率为6．1％（2／33），结核感染组和健康对照组阳性率为0。蛋白芯片检测结核病组的灵敏度为34．2％，特异度为97．4％。阳性预测值93．1％，阴性预测值58．5％。Logistic回归发现蛋白芯片检测阳性率仅与病程相关，且随病程延长而阳性率升高。病程〈1个月，蛋白芯片检测阳性率为18．8％（6／32），病程在～3个月，蛋?     

90例肺结核患者的纤支镜检查资料分析

近年来肺结发病率有上升的趋势,现将我院90例肺结核患者的纤支镜检查结果报道如下.1 资料与结果本组90例患者,均经临床表现、胸部X线、痰菌检查及治疗结果的确诊,男性64例,女性26例,年龄17～73岁,平均55岁.检前痰阳12例、痰阴72例.其中Ⅲ型肺结核进展期8例,Ⅳ型肺结核9例.纤支镜检采用日本产Olympus BF—P20纤维支气管镜及自配套附件,操作步骤及标本处理接常规.对10例刷检阳性患者配合全身抗结核治疗下进行经纤支镜局部注药治疗.在纤支镜下确认病变肺段或亚段支气管,尽可能负压吸除支气管腔内的分泌物,然后注入INH0.1～0.3或SMO.5～1.0,每次镜下治疗间隔3～4天.90例患者均行经纤支镜支气管粘膜刷检,18例检出抗酸杆菌,其中检前痰阳9例、痰阴9例,刷检总阳性率为20%.经纤支镜局部注药治疗的10例患者.全部在2个月内痰菌阴转.最早者3周.平均50天;另8例刷检阳性病人平均痰菌阴转时间超过60天,最长者3个月.     

花粉过敏性哮喘的免疫学诊断研究

对４８例与花粉过敏有关的外源性哮喘病例进行过敏史、病史、体格检查，结合花粉变应原支气管激发试验（ＢＰＴ）、皮肤挑刺试验（ＳＰＴ）、特异性ＩｇＥ（Ｓ－ＩｇＥ）及特异性ＩｇＧ（Ｓ－ＩｇＧ）检查。结果ＢＰＴ阳性率为７０．９％（３５／４８），ＢＰＴ阳性组的ＳＰＴ、Ｓ－ＩｇＥ以及Ｓ－ＩｇＧ阳性率分别为１００％，７１．４％，６２．９％，明显高于ＢＰＴ阴性组。ＳＰＴ，Ｓ－ＩｇＥ，Ｓ－ＩｇＧ与ＢＰＴ的符合率分别为     

烧伤创面院外感染

目的了解烧伤患者人院前创面受细菌沾染（感染）情况。方法通过回顾性总结1989年到1997年9月间在我科住院的不同烧伤面积患者、在不同入院时间、入院时、治疗前，创面分泌物培养结果和对临床同期所用抗生素敏感率结果1005例，进行统计分析。结果（1）9年内共作创面分泌物培养1005例，其中入院、治疗前测390例，阳性355例（91％），得细菌486株、两个以上混合感染256株（52．67％）；（2）6h内入院者阳性率为81．4％，之后随入院时间推迟，阳性率逐渐升高；（3）感染菌种：不同入院时段入院时感染菌以球菌为主（36．8％），其中金黄色葡萄球菌占23．25％；各种杆菌占38．44％；假单胞菌占19．1％；（4）24h内入院者球菌出现106株（49．3％）；杆菌占129株（50．7％，）；25h后入院者杆菌为主（71．9％）；（5）院外感染细菌以金黄色葡萄球菌（23．25％）、铜绿假胞菌（13．58％）、大肠杆菌属（9．47％）、产气肠杆菌属（8．85％）和链球菌属（6．79％）5种为主，而克雷伯菌属（5．96％）和嗜麦芽假单胞菌（4．53％）感染率亦高；（6）丁胺卡那霉素、氧氟沙星和三代头胞类，对院外感染菌种均有50％以上的敏感率。结论在烧伤感染的防治中，应注重烧伤创面的院外感染，入院后立即手术．清创和切除坏死组织，是预防院外感染的关键措施；院外感染抗生素选择的余地较大，24h内入院者，选用以针对球菌为主，兼顾杆菌；25h后入院者选用针对以杆菌为主兼顾球菌。     

结核性淋巴结炎的组织细胞反应性增生变型

应用结核杆菌ＤＮＡ１２３ｂｐ特异性序列片段为靶序列的多聚酶链反应（Ｍ·ＴＢ－ＰＣＲ）技术、ＢＣＧ免疫组化（ＢＣＧ－ＩＨＣ）技术和抗酸染色（ＡＦ）方法，对３８例呈现组织细胞反应性增生－碎屑样坏死－嗜中性白细胞渗出病变的淋巴结石蜡包埋组织进行了分支杆菌／结核杆菌的回顾性检测。三种方法的综合阳性率为５２．６％（２０／３８例）。ＡＦ、ＢＣＧ－ＩＨＣ和Ｍ·ＴＢ－ＰＣＲ的各自阳性率分别为０．８％、２６．３％和５０％。研究结果表明：（１）在按本文标准选择的淋巴结“组织细胞反应性增生”病变中，有半数病例与结核杆菌的感染有关，即结核性淋巴结炎可呈现“组织细胞反应性增生”之类的变型；（２）ＰＣＲ技术在结核性淋巴结炎的病原学诊断上具有重要价值。     

东莞地区50387例高考学生HBsAg检测结果分析

目的了解东莞地区中学生乙型肝炎病毒（hepatitis B virus，HBV）的感染现状，为HBV感染的防治提供依据。方法采用酶联免疫吸附试验方法（ELISA法）分别检测2001-2007年高考体检学生共50387人的HBsAg，对检测结果统计分析，比较不同性别和城乡间的HBsAg感染的差异。结果2001-2007年高考学生HBsAg的携带率分别为23．69％、18．58％、16．22％、14．88％、10．98％、6．68％、4．04％，呈逐年下降趋势（P〈0．01）；乡镇学生HBsAg平均阳性率为12．65％，显著高于城镇学生的平均阳性率8．75％（P〈0．01）；男性的HBsAg阳性率为12．86％，显著高于女性的阳性率9．2％（P〈0．01）。结论被调查的东莞市2001-2007年高考学生的HBV感染率（平均感染率11，14％）高于全国的HBV平均感染率（10％），HBsAg的携带率呈逐年下降趋势；乡镇学生HBV感染率明显高于城镇学生，男生高于女生。     

Comparative analysis of various cytohistological techniques in diagnosis of lung diseases

A prospective study was conducted on 100 patients divided in two groups who underwent fiberoptic bronchoscopy (FOB). Group I consisted of 60 cases of suspected lung malignancy on clinical and radiological examination, while group II consisted of 40 cases of nonneoplastic lung diseases. Pre-FOB sputum, bronchoalveolar lavage (BAL), and bronchial brushing (BB) were done in all the cases, while forceps biopsy (FB), transbronchial needle aspiration (TBNA), and transthoracic needle aspiration were done in 56, 25, and 15 patients, respectively. BB and FB showed a sensitivity of 70.83 and 70% respectively in the diagnosis of malignancy. BAL was found to be positive in 37.5% patients. TBNA had the highest sensitivity of 83.33% whereas pre-FOB sputum and post-FOB sputum were positive only in 27.58 and 29.06% cases. In nonneoplastic group, BAL showed sensitivity of 80 and 83.33% in diagnosing tuberculosis and fungal diseases whereas BB was positive in 60 and 66.66% patients, respectively. Thus a combination of various cytohistological techniques results in a statistically significant increase in the diagnostic yield of various neoplastic and nonneoplastic lung diseases. BB, FB, and TBNA are complimentary in diagnosis of various lung malignancies whereas BAL is a useful procedure in detection of infectious diseases.     

Potentials of the cytological method in the differential diagnosis of infiltrative processes of various etiology in the lungs

Results of examination of 143 patients with the lung infiltrative lesions of various etiology (tuberculosis, carcinoma, acute pneumonia) are analysed. Cytological examination of the sputum, bronchial smears and lavage liquid allowed one to diagnose cytologically lung carcinoma in 67% and tuberculosis in 36% cases. Certain combinations of nonspecific cell elements in the bronchial content also helped to make the differential diagnosis between the infiltrative tuberculosis, carcinoma and acute pneumonia. The most informative is the examination of the lavage liquid.     

Sialadenoma papilliferum of the bronchus: Rare tracheobronchial tumor of salivary gland type

Presented herein is the second case of sialadenoma papilliferum of the bronchus in a 75-year-old man. The bronchial tumor had an exophytic papillary lesion protruding into the lumen of the ostial region of the right superior lobe bronchus on chest CT and bronchoscopy. Grossly, the resected tumor was pedunculated, 5 × 3 × 3 mm in size and consisted of both an exophytic papillary lesion protruding into the bronchial lumen and a glandular component in the bronchial submucosa. Histologically, the papillary structures were lined by ciliated or non-ciliated columnar epithelium and metaplastic non-keratinizing stratified squamous epithelium. The submucosal glandular components were well circumscribed beneath and in continuity with the papillary lesion. The glandular components of cysts and duct-like structures were lined by a double-layer epithelium composed of luminal cells and basal cells. Sialadenoma papilliferum is a rarely recognized salivary gland tumor, mostly occurring at intraoral mucosal sites including the hard and soft palate and buccal mucosa. There have been sporadic cases of sialadenoma papilliferum of the esophagus, nasopharynx and nasal cavity. To the authors' knowledge only one case of sialadenoma papilliferum of the bronchus has been reported previously.     

Role of Airway Eosinophilia and Eosinophil Activation in Sephadex-induced Inflammation

The effects of an intravenous injection of Sephadex beads on lung eosinophil infiltration and eosinophil peroxydase activity and its relationship to bronchial hyperresponsiveness was examined in guinea pigs. This Sephadex beads injection led to blood, lung and airway eosinophilia in association with bronchial hyperresponsiveness. Histologic examination of the lower bronchus indicated that the eosinophil number increased markedly in the mucosa and submucosa. In addition, the eosinophils surrounding the bronchioles 1 day after the Sephadex injection migrated further in airway submucosa and mucosa 7 and 14 days after. Moreover, the bronchial hyperresponsiveness is observed without histologic evidence of airway epithelium damage. Therefore, the bronchial hyperresponsiveness seems to be more related to the eosinophil infiltration in the airway epithelium and possibly eosinophil activation rather than to the eosinophil number recovered in the BAL fluid. We conclude that the maintenance of hyperresponsiveness state could be associated with the persistence of blood and airway eosinophilia.     

Efficacy of fluorochrome stain in the diagnosis of pulmonary tuberculosis co-infected with HIV

The resurgence of Mycobacterium tuberculosis in association with HIV infection has focussed much attention in the rapid diagnosis of high risk cases. Infection with HIV is known to alter the presentation of pulmonary tuberculosis. The present study was under taken to compare the efficacy of fluorochrome stain (Fl) with conventional Ziehl Neelsen (ZN) stain in the diagnosis of pulmonary tuberculosis. Two hundred cases of pulmonary tuberculosis were included in the study. Sputum smears were screened for acid fast bacilli (AFB) by ZN and Fl methods and blood samples were screened for HIV. Sputum positive cases detected by Fl stain were higher in number (69%) when compared to ZN stain (50%). Of the total cases studied 15.5% were HIV seropositive. CONCLUSIONS: Fluorochrome staining was found to be more efficient (45%) when compared to ZN staining (29%) in detecting cases associated with HIV seropositivity, especially paucibacillary cases.     

Transbronchial needle aspiration biopsy in the diagnosis of peripheral lung lesions

In 1996-2000 in 55 patients (16 females, 39 males) admitted to Department of Phtisiopneumonology in Zabrze because of peripheral lung lesions (diameter 2.5-9.5 cm mean 4.5 cm). The transbronchial aspiration needle biopsy (TANB) was performed as diagnostic procedure during fiberoptic bronchoscopy. Subjects classified to TANB showed no pathologic changes in the bronchial tree during fiberoptic bronchoscopy. In all subjects the TANB was performed using special Wang's needles and always under fluoroscopy supervision. Based on pathologic examination of specimens obtained by Wang's needle the diagnosis was established in 29 (52.7%) cases. The most frequent diagnosis was non small cell carcinoma--in 22 (40%) of examined patients. The small cell carcinoma was confirmed only in 1 patient. In 3 (5.5%) patients tuberculosis was diagnosed. TANB was good tolerated by almost all patients, only in 1 patient small pneumothorax was recorded and in 6 cases small bleeding occurred. We conclude that transbronchial aspiration needle biopsy is safe and efficient method in diagnosis of peripheral lung tumors.     

Endobronchial aspergilloma: report of 10 cases and literature review

Purpose

A retrospective investigation of the clinical and radiologic features as well as the bronchoscopic appearance was carried out in patients with endobronchial aspergilloma.

Materials and Methods

Ten patients with endobronchial aspergilloma diagnosed by bronchoscopy and histological examination were identified at the Gyeongsang University Hospital of Korea, from May 2003 to May 2009.

Results

The patients included 9 men and 1 woman, and the age of the patients ranged from 36 to 76 (median, 58 years). The associated diseases or conditions were: previous pulmonary tuberculosis in 7 patients, lung cancer in 2 patients, pulmonary resection in 1 patient, and foreign body of the bronchus in 1 patient. The chest radiologic finding showed fibrotic changes as a consequence of previous tuberculosis infection in 6 patients and a mass-like lesion in 2 patients. Two patients had a co-existing fungus ball, and an endobronchial lesion was suspected in only 2 patients on the CT scan. The bronchoscopic appearance was a whitish to yellow necrotic mass causing bronchial obstruction in 7 patients, foreign body with adjacent granulation tissue and whitish necrotic tissue in 1 patient, whitish necrotic tissue at an anastomosis site in 1 patient, and a protruding mass with whitish necrotic tissue in 1 patient.

Conclusion

An endobronchial aspergilloma is a rare presentation of pulmonary aspergilosis and is usually incidentally found in immunocompetent patients with underlying lung disease. It usually appears as a necrotic mass causing bronchial obstruction on bronchoscopy and can be confirmed by biopsy.     

多层螺旋CT对小儿不典型气管、支气管非金属异物的诊断价值

目的评价多层螺旋CT在小儿不典型气管、支气管非金属异物诊断中的价值。方法回顾性分析30例（男性19例，女性11例，年龄1～5岁，平均年龄3．5岁）经纤维支气管镜检查证实的小儿不典型气管、支气管非金属异物患儿资料,每一患儿均进行多层螺旋CT扫描（层厚2mm，间隔1～2mm，螺距1～2，电压120kV，电流200mA），重建处理包括多平面重建（MPR）、最小密度投影（Min P）和CT仿真内窥镜（CTVE）技术（重建层厚1mm，间隔0．5mm）。使气管、支气管清晰显示，观察非金属异物的有无、位置及其并发症。结果气管异物3例；右侧支气管异物23例，其中右主支气管异物10例．右中间段支气管异物9例，右下叶支气管异物3例，右中叶支气管异物1例；左主支气管异物3例，左下叶支气管异物1例。4种显示方法对小儿不典型气管、支气管非金属异物诊断的敏感性分别为86．7％（26／30）、83.3％（25／30）、70．0％（21／30）、53．3％（16／30）。结论多层螺旋CT是一种非侵入性、无痛苦、安全、易为小儿所接受的检查方法，对小儿不典型气管、支气管非金属异物的诊断、术前筛选、定位、了解手术路径及术后复查等有很大的价值。     

Are three sputum acid-fast bacillus smears necessary for discontinuing tuberculosis isolation?

To evaluate the efficacy of three sputum acid-fast bacillus (AFB) smears to rule out pulmonary tuberculosis, sputum AFB smear and culture results were analyzed at two university-affiliated teaching hospitals. The negative predictive value of the smear increased by only 0.2% on days 2 and 3 each, indicating that in low-prevalence populations, there is limited value in requiring three negative sputum AFB smears before discontinuing tuberculosis isolation.     

Endobronchial actinomycosis simulating endobronchial tuberculosis: a case report.

We report a case of a 70-year-old woman who presented with mild exertional dyspnea and cough. Fiberoptic bronchoscopic findings revealed an endobronchial polypoid lesion with stenotic bronchus. The lesion was very similar to endobronchial tuberculosis. Histologic examination of the biopsy specimen demonstrated Actinomyces infection. There was a clinical response to intravenous penicillin therapy. Primary endobronchial actinomycosis must be considered in the differential diagnosis of an endobronchial lesion, especially endobronchial tuberculosis in Korea.