儿童肺结核支气管肺泡灌洗液Xpert MTB/RIF检测的诊断准确性研究

目的探讨支气管肺泡灌洗液的Xpert MTB/RIF检测对儿童肺结核的诊断价值。方法有疑似活动性结核病的临床症状和体征,行纤维支气管镜检查并留取了支气管肺泡灌洗液的患儿为研究对象。以支气管肺泡灌洗液作为病原学检测标本,分别以病原学诊断活动性结核病和临床诊断活动性结核病为金标准,以Xpert MTB/RIF为待测标准,考察Xpert MTB/RIF对病原学和临床诊断结核的诊断价值。基于样本中结核分枝杆菌(MTB)的Ct值反映所检测样本中MTB的载量;通过对利福平耐药位点的检测,对MTB菌株进行药物敏感性检测。结果符合本文纳入标准的疑似结核病患儿351例,男198例,女153例,年龄(5.9±3.9)岁。肺结核患儿125例,其中病原学诊断结核43例(34.4%),临床诊断结核82例(65.6%);肺结核合并支气管结核51例(40.8%),单纯肺结核74例(59.2%);非结核呼吸道感染性疾病226例,肺炎支原体肺炎187例(82.7%),细菌性肺炎39例(17.3%)。Xpert MTB/RIF在病原学诊断和临床诊断结核的敏感度分别为79%(95%CI:63%～89%)和51%(95%CI:40%～62%),差异有统计学意义(χ~2=9.18,P=0.002);肺结核合并支气管结核的敏感度为80%(66%～90%),单纯肺结核的敏感度47%(35%～59%);病原学诊断和临床诊断结核、合并支气管结核和单纯肺结核特异度均为100%(95%CI:97.9%～100%)。Xpert MTB/RIF检测病原学诊断结核敏感度高于临床诊断结核,肺结核合并支气管结核敏感度高于单纯肺结核,差异有统计学意义(χ~2=13.88,P0.001);支气管肺泡灌洗液的MTB核酸检出载量病原学诊断结核高于临床诊断结核,差异有统计学意义(χ~2=7.37,P=0.025)。76例Xpert MTB/RIF检测阳性患儿中,利福平耐药2例(2.6%)。结论支气管肺泡灌洗液的Xpert MTB/RIF检测在儿童肺结核诊断中具有较高价值,可在缺乏细菌学诊断证据的临床诊断结核病儿童中发现MTB,具有较高的敏感度,有助于提高儿童结核病病原学检出率。     

支气管肺泡灌洗液荧光定量PCR对儿童肺炎支原体肺炎诊断研究

目的探讨荧光实时定量PCR(FQ-PCR)检测肺泡灌洗液(BALF)中MP-DNA基因在肺炎支原体肺炎(MPP)早期病原诊断中的价值。方法采用FQ-PCR检测61例患儿BALF中MP-DNA,并与目前常用血清MP抗体检测方法颗粒凝集法进行比较。结果 FQ-PCR检测MP-DNA敏感度94%,特异度100%;病程早期及难治性病例中FQ-PCR检测BALF中MP-DNA准确性优于单份血清MP抗体检测(P<0.01)。难治性病例中MP-DNA拷贝数显著高于普通MPP组(P<0.05),且与CRP呈正相关(r=0.845,P<0.01)。结论 FQ-PCR检测BALF中MP-DNA是早期MPP特别是难治性MPP病原诊断的可靠方法,优于血清MP抗体检测。MP-DNA的拷贝量可以作为评价难治性MPP的转归以及判断药物疗效的指标。     

支气管肺泡灌洗诊断儿童、少年呼吸器官疾病

4～17岁儿童、少年呼吸器官疾病101例进行了支气管肺泡灌洗(BAL)诊断。方法儿童在麻醉下,采用Фридель或Шторц呼吸支气管镜进行BAL。少年以10%利多卡因和5%美索卡因(Trimecaine)局麻,经纤维支气管镜施行BAL。内窥镜进入粗支气管(叶和段支气管),如有大量脓性分泌物或支气管粘膜特异性渗出性病变,不宜灌洗,以避免细菌带入远端支气管和肺泡。如无上述病变,则经支气管镜呼吸管将金属管插至段支气管出口处,通过金属管将7、8号X 线造影导管推进2～3cm(儿童)或3～4cm(少年)至5～6级支气管。经支气管镜直接将4～6号导管插入所选择的段支气管出口处。在X 线电视屏下监视导管位置。从导管向所造择的肺段灌注38～39℃,pH7.2～7.4灭菌生理溶液40～100ml(依据年龄分次灌注,每次10     

重症肺炎儿童支气管肺泡灌洗液中的树突状细胞变化

目的通过研究重症肺炎患儿支气管肺泡灌洗液(BALF)中成熟树突状细胞(DC)的数量与白介素12(IL12)以及临床评分的关系,了解DC在重症肺炎发生、发展中的作用。方法2002年11月～2003年5月我院重症监护病房收治的重症肺炎患儿27例为重症肺炎组,同期呼吸组收治的普通肺炎患儿30例作为普通肺炎组,选取同期在本院胸外科收治的胸部手术患儿29例,作为对照组。重症肺炎组和对照组在插管第1天和第2天取BALF测定成熟DC,并对重症肺炎组和普通肺炎组进行肺部炎症程度的临床评估,三组患儿在入院第1天采血,用ELISA方法检测IL12。结果插管当天和插管第2天重症肺炎组BALF中成熟DC百分率高于对照组,两组有显著差别(P均<0.01);重症肺炎组中插管当天成熟DC百分率略高于插管第2天,但无统计学意义(P=0.05);插管当天成熟DC百分率与急性肺损伤评分呈正相关(r=0.37,P<0.05),与儿童危重评分无显著相关性(r=-0.11,P>0.05)。重症肺炎组中IL12浓度高于普通肺炎组(P<0.01),和对照组比较(P<0.01),有统计学意义;普通肺炎组中IL12浓度显著高于对照组(P<0.01),有统计学意义;插管当天成熟DC百分率与IL12呈正相关(r=0.48,P<0.01)。结论儿童重症肺炎中肺部DC的过度成熟、活化与病情严重程度相关,并伴随着IL12水平的升高,这表明其从启动环节上影     

无肺部病变儿童支气管肺泡灌洗液成分分析

为建立儿童支气管肺泡灌洗液 (ＢＡＬＦ)细胞及肺表面活性物质成分的参照值。应用生化及免疫印迹法对无肺部病变的 2 0例手术患儿的ＢＡＬＦ行细胞学及肺表面活性物质成分分析。结果回收率为 4 6 .6 %。细胞总数为 15 .6× 10 4/ｍｌ,巨噬细胞占 93.9% ,淋巴细胞占 4 .5 %。总磷脂 (ＴＰＬ)为 4 6 .6 μｇ/ｍｌ,饱和卵磷脂 (ＤＳＰＣ)为 17.9μｇ/ｍｌ,总蛋白(ＴＰ)为 72 .2 μｇ/ｍｌ,ＤＳＰＣ/ＴＰＬ为4 2 .2 % ,ＤＳＰＣ/ＴＰ为0 .2 8,肺表面活性物质蛋白Ａ(ＳＰ Ａ)为 1.91μｇ/ｍｌ。细胞总数、ＴＰＬ、ＴＰ、ＳＰ Ａ与年龄无显著相关…     

支气管肺泡灌洗在儿童肺部感染病原学诊断中的应用

支气管肺泡灌洗(bronchoalveolar lavage,BAL)是指通过纤维支气管镜(简称纤支镜)或在气管插管下对目的肺段进行灌洗并回收小气道与肺泡衬液的一种检查方法.     

支气管肺泡灌洗液G试验对儿童重症监护病房侵袭性肺部真菌感染诊断价值研究

目的探讨支气管肺泡灌洗液(BALF)G试验检测在儿童重症监护病房(PICU)侵袭性肺部真菌感染(IPFI)中的临床价值。方法收集2012年12月至2013年6月在广西壮族自治区妇幼保健院PICU病房治疗,高度怀疑为IPFI的患儿60例。均行BALF、血清G试验检测,比较两者的阳性率,根据结果对阳性患儿行抢先氟康唑抗真菌治疗,疗效不佳者根据BALF培养结果或临床经验改予伏立康唑、伊曲康唑、两性霉素B等抗真菌治疗,并分别于抗真菌治疗7 d、14 d后复查并分析其变化趋势。结果 BALF G试验阳性率(88.3%,53/60)明显高于血清G试验阳性率(30%,18/60)(χ2=29.64,P0.01)。抗真菌治疗有效组患儿治疗7 d、14 d后的BALF及血清G试验结果(ng/L)与治疗前比较有明显降低趋势(BALF:698.33±213.86,490.03±157.79,207.07±66.19,血清:338.50±109.15,222.86±59.72,103.89±27.47),结果两两比较差异均有统计学意义(F值分别为204.69、61.18,均P0.01)。结论BALF G试验在PICU病房高度怀疑为IPFI患儿中的检出率很高,可用于IPFI的早期诊断,且动态监测其变化可用于抗真菌治疗临床疗效的评价。     

下呼吸道感染患儿支气管肺泡灌洗液的病原学研究

目的 研究下呼吸道感染患儿病原体特点,为临床医生合理使用抗生素提供依据。方法 选取2017年1月至2018年6月因下呼吸道感染住院且接受纤维支气管镜治疗的108例患儿为研究对象,收集其支气管肺泡灌洗液,通过多重实时荧光PCR检测其病原体。结果 在108例患儿中,检测出病原体85例（78.7%）,其中单一病原体感染检出52例（48.1%）,多重病原体感染检出33例（30.6%）。肺炎支原体检出率最高,共检出38例（35.2%）,其中36~ < 72月龄患儿检出率最高;其次为肺炎链球菌及流感嗜血杆菌,各检出29例（26.9%）,其中肺炎链球菌主要集中于24月龄以下患儿。检出率较低的为鲍曼不动杆菌、白色念珠菌及肺炎克雷伯杆菌,各检出3例（2.8%）。在31例支气管肺炎患儿中,流感嗜血杆菌检出率最高（9例,29%）。在34例大叶性肺炎患儿中,肺炎支原体检出率最高（22例,65%）。在22例支气管异物合并支气管肺炎患儿中,肺炎链球菌检出率最高（10例,45%）。结论 在下呼吸道感染患儿中,肺炎支原体检出率最高,其次为肺炎链球菌及流感嗜血杆菌。不同年龄、不同类型下呼吸道感染患儿的病原体检出率存在差异。     

支气管肺泡灌洗液肝素结合蛋白水平对儿童重症肺炎的评价作用

目的:探讨支气管肺泡灌洗液肝素结合蛋白(HBP)水平对儿童重症肺炎的病情评价作用。方法:纳入湖南省儿童医院行支气管镜检测及支气管肺泡灌洗术的重症肺炎患儿94例,检测支气管肺泡灌洗液中HBP水平。根据病原学结果,分为非细菌感染组(19例)和细菌感染组(75例);根据是否存在急性呼吸窘迫综合征(ARDS)及其严重程度分为非...     

Xpert结核分枝杆菌/利福平试验对结核病及耐多药结核病诊断价值的Meta分析

目的 评估Xpert结核分枝杆菌/利福平（MTB/RIF）试验对结核病的诊断价值。方法 检索PubMed、Medline、中国知网、万方数据库等,收集Xpert MTB/RIF试验对结核病诊断价值的文献,检索起止时间均为建库至2012年6月。2名研究者独立进行资料提取和文献质量评估。采用Meta-Disc 1.4软件进行Meta分析。结果 共纳入26篇文献,其中2篇文献涉及儿童病例,包含了13 270例来自临床患者的检测标本。Meta分析结果显示,Xpert MTB/RIF试验诊断结核病的汇总敏感度为87%（95％CI:86%~88%）、特异度为97%（95％CI:97%~97%）。按照结核病的类型和患者年龄进行亚组分析,Xpert MTB/RIF试验诊断肺结核的敏感度高于肺外结核病,90%（95％CI:89%~91%） vs 76%（95％CI:72%~79%）;诊断涂阴菌阳性和涂阳菌阳性结核病的敏感度分别为74%（95％CI:71%~76%）和99％(95%CI:98%~99%);对儿童肺结核的诊断敏感度比成人肺结核低,74%（95％CI:65%~83%） vs 90%（95％CI:89%~92%）。Xpert MTB/RIF试验诊断耐多药结核病的敏感度为96%（95％CI:94%~97%）,特异度为98%（95％CI:98%~99%）。结论 Xpert MTB/RIF试验诊断结核病的价值较高,尤其是成人结核病及耐多药结核病。Xpert MTB/RIF试验在儿童结核病中的诊断价值由于纳入文献较少,尚待进一步研究。     

Differential cytology of bronchoalveolar lavage fluid in immunosuppressed children with pulmonary infiltrates.

OBJECTIVE: Bronchoalveolar lavage (BAL) is a well established technique for the detection of pathogens in immunosuppressed children, but its diagnostic yield is variable. The aim of this study was to investigate whether BAL differential cell counts are helpful in the evaluation of pulmonary infiltrates in immunocompromised children. STUDY DESIGN: BAL was performed 28 times in 27 febrile immunocompromised children with pulmonary infiltrates. All patients were pretreated with broad spectrum antibiotics; 11 children also received amphotericin B. BAL was conducted with a flexible bronchoscope wedged in the area of maximal pathology as suggested by the chest radiograph or in the middle lobe in patients with diffuse interstitial radiographic changes. Differential cell counts were performed from cell smears obtained after centrifugation of BAL fluid. RESULTS: Bacterial or fungal organisms were detected in BAL fluid of 12 patients. Patients with bacterial or fungal infections (group 1) had a significantly higher percentage of granulocytes in BAL fluid both compared with patients with sterile BAL cultures (group 2) and with a control group of children without pulmonary disease (p < 0.001, Wilcoxon test). The proportion of lymphocytes was not different from the control group in group 1 but significantly increased in group 2 (p < 0.001, Wilcoxon test). Blood differential cell counts were not different in the two patient groups. Lymphocyte subsets of BAL fluid obtained in a subgroup of patients were not significantly different from controls. CONCLUSION: These data suggest that BAL differential cell counts may be a useful adjunct in the differential diagnosis of pulmonary infection in immunocompromised children.     

Diagnostic Yield of Xpert MTB/RIF in Bronchoalveolar Lavage in Children with Probable Pulmonary Tuberculosis

Objective

To evaluate utility of Xpert MTB/RIF in bronchoalveolar lavage fluid in children with probable pulmonary tuberculosis.

Methods

Children with probable pulmonary tuberculosis with negative smear and Xpert on induced sputum/gastric aspirate were subjected to bronchoalveolar lavage (BAL) for Xpert assay and mycobacterial liquid culture. Data of children <14 y undergoing bronchoscopy for suspected MDR-TB (n=12) were also analyzed. The sensitivity of Xpert in BAL fluid for diagnosis of probable and confirmed pulmonary tuberculosis was calculated with clinico-radiological diagnosis and culture as gold standards, respectively.

Results

Of 41 enrolled children, 24 (58.5%) had Xpert positive in BAL fluid and 11 (26.8%) had culture confirmed tuberculosis (BAL fluid;10; sputum,1). The sensitivity of Xpert in BAL fluid among probable and culture confirmed tuberculosis cases was 58.5% (24/41) and 81.8% (9/11), respectively.

Conclusion

Xpert in bronchoalveolar lavage fluid has good sensitivity in both probable and confirmed pulmonary tuberculosis in children.

     

Gastric lavage is better than bronchoalveolar lavage for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis.

We compared the sensitivity of gastric lavage (GL) with bronchoalveolar lavage (BAL) for isolating Mycobacterium tuberculosis (Mtb) from 20 children with a presumptive diagnosis of primary pulmonary tuberculosis. GL was performed on three consecutive mornings after an overnight fast. BAL was performed on the same day as the last GL. Specimens were submitted for smears and culture for Mtb. None of the acid-fast stained smears was positive. Cultures of BAL fluid on 2 patients (2 of 20 or 10%) were positive for Mtb. Cultures of the gastric aspirates from the same 2 patients were also positive for Mtb. Eight additional patients had positive GL cultures with negative BAL cultures, resulting in a total of 10 of 20 (50%) patients with positive GL cultures for Mtb. The results of our study indicate that GL done on three consecutive days is better than BAL for the bacteriologic diagnosis of childhood pulmonary tuberculosis.     

Immunoglobulin levels in bronchoalveolar lavage fluid of children with recurrent obstructive bronchitis

Bronchoalveolar lavage was performed in 22 children with recurrent obstructive bronchitis and the recovered lavage fluid samples were analysed for concentration of IgA, IgG, IgM, IgE and C3. Previously a significant influx of exudate macrophages and persistence of bacteria on the bronchoalveolar surface were detected in these patients and a severe mucosal inflammation was observed bronchoscopically. The relative lavage fluid levels of immunoglobulins to albumin were significantly higher than in serum, indicating a local production of these proteins. The elevated levels of C3 indicated a high activity of the macrophages and the complement system. It is concluded that the mucosal inflammation in patients with recurrent obstructive symptoms cannot be attributed to a deficiency of immunoglobulins either in blood or in bronchial secretions.