经纤维支气管镜刷检联合活检对痰菌阴性肺结核患者的诊断价值的初步研究

目的探讨支气管镜刷检联合活检对痰菌阴性肺结核患者的诊断价值。方法 68例痰菌阴性肺结核患者的治疗前进行支气管镜检查,同时行刷检、活检、刷检联合活检三种方法 ,了解不同方法对肺结核诊断的阳性率。结果活检病例中,阳性率为41.7%,刷检涂片病例中,阳性率为29.2%,刷检联合活检阳性率为62.5%,（P=0.043）。结论经纤维支气管镜刷检联合活检可提高痰菌阴性肺结核患者的阳性诊断率。     

多种手段在肺部肿瘤诊断中的应用分析

目的探讨纤维支气管镜(纤支镜)刷检/针吸/活检、肺穿刺组织病理学/细胞学与痰液细胞学在肺部肿瘤诊断中的应用。方法纤支镜在病变部位刷片、针吸或活检;CT引导下肺部病变部位穿刺;取晨痰或新鲜痰液涂片作细胞学检查。结果本组617例患者,经临床或病理学确诊为肺癌患者525例,应用纤支镜、肺穿刺及痰液细胞学诊断肺癌432例,占82.3%;其中纤支镜刷检/针吸/活检阳性318例,占60.6%;肺穿刺阳性108例,占20.6%;痰液细胞学阳性104例,占19.8%(其中痰液细胞学单独阳性者6例,占1.1%)。结论纤维支气管镜刷检/针吸/活检与CT引导下肺穿刺组织病理学/细胞学检查,在肺部肿瘤的诊断中有重要的应用价值;痰细胞学检查简便易行,可作为纤支镜检查阴性和不能耐受纤支镜检查的肺癌患者的补充手段,在肺部肿瘤的筛查中有重要的意义。多种手段联合检查,可进一步提高肺部肿瘤诊断的阳性率。     

CT引导下经皮肺穿刺活检术对肺隐球菌病的诊断价值

目的探讨CT引导下经皮肺穿刺活检术（PCNB）对肺隐球菌病的诊断价值。方法回顾性分析本院PCNB诊断肺隐球菌病的4例患者病例资料,所有4例患者均行痰涂片检查、胸X线检查、肺CT检查及纤维支气管镜检查、CT引导下经肺穿刺活检术（PCNB）,检出物送病理检查。结果4例患者痰涂片、纤维支气管镜均为阴性,肺CT及胸X线表现为多发实变或结节状阴影。4例患者均经CT引导下行经肺穿刺活检术（PCNB）,榆出物送病理检查找到隐球菌而确诊。穿刺后无明显并发症。结论对临床难于确诊的肺隐球菌病,CT引导下PCNB是一种安全有效的诊断方法。     

多种技术联合应用对肺癌诊断的临床价值

目的评价多种技术联合应用对肺癌诊断的临床价值。方法 884例痰脱落细胞学、细菌学、常规支气管镜等检查均无阳性发现的疑似肺癌的患者行经支气管镜针吸活检术（TBNA）和活检刷检、经支气管镜超声引导针吸活检术（EBUS-TB-NA）、纵隔镜、超声或CT引导经皮肺穿刺活检术、PET-CT和内科电子胸腔镜胸膜活检术。结果 215例患者TBNA、刷检、活检的阳性率分别为81.58%、29.47%和16.84%。15例EBUS-TBNA的阳性率为91.67%,20例超声或CT引导经皮肺穿刺活检术阳性率为65%,10例PET-CT阳性率为80%,628例患者胸腔镜检查的总体阳性率为94.6%。结论多种技术联合应用可明显提高肺癌的早期诊断率。     

经皮肺穿刺活检术对无反应肺炎的价值

目的评价CT引导下经皮肺穿刺活检术对无反应肺炎病原学诊断的价值。方法呼吸内科住院患者无反应性肺炎26例,均在CT引导下经皮肺穿刺活检术进行抗酸染色、革兰氏染色、细菌和真菌培养及病理学检查。结果 19例(73.08%)明确了病原菌,其中培养出铜绿假单胞菌2例,肺炎链球菌2例,抗酸染色阳性及病理学检查支持肺结核10例,隐球菌肺炎4例,培养出烟曲霉菌1例,肺腺癌1例,6例为慢性炎症改变。而痰细菌培养或支气管镜下支气管分泌物或支气管肺泡灌洗液细菌培养出阳性结果 4例(25.00%)。结论 CT引导下经皮肺穿刺活检术穿刺成功率高,对无反应肺炎的病原学诊断的敏感性及特异度均较理想,有较好的应用价值。     

CT引导下经皮肺活检的临床应用

目的探讨CT引导下经皮肺穿刺活检对肺部周围型病变的诊断价值。方法对痰细胞学阴性及纤维支气管镜不能确诊的58例肺部周围型病变患者，在胸部CT定位下，用活检针经皮肺穿刺活检取材，行病理学诊断。结果58例患者的诊断阳性率为94．8％（55／58），阴性率5．2％（3／58），术后气胸7例，小量咯血2例。结论CT引导下经皮肺穿刺活检是一种安全的检查手段，对周围型肺部病变具有较高的诊断价值。     

CT引导下经皮肺穿刺活检对侵袭性肺真菌感染的诊断价值

目的探讨CT导向下经皮肺穿刺活检对侵袭性肺真菌感染的诊断价值。方法回顾性分析32例侵袭性肺真菌感染的病例资料,所有病例均行痰涂片、胸X线检查、胸部CT检查、纤维支气管镜检查、CT引导下经皮肺穿刺活检术,检出物送病理检查。结果 7例患者痰培养真菌阳性,纤维支气管镜检查肺泡灌洗液真菌培养均阴性,肺CT及胸X线表现为多发实变、结节状阴影、新月征、斑片状阴影、空洞征等。32例患者均经CT引导下经皮肺穿刺活检术（PCNB）,其中28例检出物病理检查确诊为真菌感染。穿刺后无严重并发症。结论对肺部难以确诊的侵袭性肺真菌病,CT引导下经皮肺穿刺活检是一种安全有效的方法。     

两种组织活检术在肺部块影鉴别诊断中的对比性分析

目的对比分析经纤维支气管镜（下称纤支镜）活检和CT引导下经皮肺穿刺活检在肺部块影鉴别诊断中的临床价值。方法符合研究的144例肺部块影患者,按CT检查影像学特点将病人分为中央型和周围型两组,病例分别接受纤支镜和CT引导下经皮肺穿刺肺组织活检,继后送病理学检查。对比两种组织活检方法的阳性率及并发症。结果中央型块影患者纤支镜检查阳性率为94.7%,CT引导下经皮肺穿刺活检阳性率20%;周围型块影患者纤支镜检查阳性率为60%,CT引导下经皮肺穿刺活检阳性率为92.8%。结论在肺部块影的鉴别诊断方法中,对于中央型患者宜首选纤支镜活检,而对于周围型患者宜选用CT引导下经皮肺穿刺活检。     

CT引导经皮穿刺活检在肺部肿块诊断中的诊断价值与安全性

目的 探讨应用Bard活检针存CT引导下肺穿刺活检的诊断准确性和安全性。方法 对痰细胞学阴性，纤支镜不能确诊的36例肺部外周性病变患者存肺部CT扫描定位下，应用Bard活榆针经皮肺穿刺活榆取材，行病理学诊断。结果 36例病人穿刺36次，阳性33例（91.6％），阴性3例（8．4％）。总检出率91.6％，其中恶性病变率为86．1％，术后少量咯血2例。结论 应用Bard活榆针在CT引导下经皮肺活榆是一种安全、有效的检查手段，对肺周围性病变具有较高的诊断价值。     

CT引导下经皮肺活检对涂阴不典型肺结核的诊断

对18例痰涂片阴性、无结核中毒症状或伴X线及CT表现不典型的肺结核患者在CT引导下经皮肺穿刺活检取材,行病理学及细胞学诊断。结果显示,18例患者均获病理确诊,经正规抗结核治疗6～9个月,大部分病灶缩小、纤维化、钙化,少部分病灶吸收。认为CT引导下经皮肺活检作为一种诊断方法,能获得足够的组织标本,具有很高的敏感性和特异性,对痰涂片阴性不典型肺结核,具有很高的诊断价值。     

Diagnostic value of bronchoscopy in diagnosis of pulmonary tuberculosis: bronchial aspirate, bronchial washing and transbronchial lung biopsy

The diagnosis of pulmonary tuberculosis is confirmed by the detection of Mycobacterium tuberculosis in sputum. Bronchoscopy has been used for diagnosis of various pulmonary diseases. The value of bronchoscopy such as bronchial aspirate, bronchial washing and transbronchial lung biopsy in diagnosis of pulmonary tuberculosis was evaluated, and the results were as follows: 1) One hundred ninety cases were investigated bronchoscopically due to suspicion of pulmonary tuberculosis with sputum negative smear and 92 cases were confirmed to be pulmonary tuberculosis. 2) Out of 91 cases examined by bronchial aspirate and 46 cases by bronchial washing, smear positivity was 20.9% and 23.9% and culture positivity was 58.2% and 84.8%, respectively. Transbronchial lung biopsy showed positive findings of tuberculosis in 75.8% out of 33 specimens. 3) Out of 88 sputa taken before bronchoscopy and 50 sputa after bronchoscopy, smear positivity was 0% and 12%, and culture positivity was 54.5% and 40% respectively. Gastric lavage culture positivity was 29.4% in 17 cases examined. 4) Diagnosis of tuberculosis was made rapidly in 28 cases (30.4%) by smear positive results of bronchial aspirate, bronchial washing and sputa after bronchoscopy, and relatively rapidly in 20 cases (21.7%) by transbronchial lung biopsy.     

新疆维吾尔自治区综合医疗机构痰检质控工作评价

目的分析新疆维吾尔自治区综合医疗机构痰检质控工作情况,探讨提高痰检质量的有效措施。方法根据自治区疾病预防控制中心结核病控制中心对全区综合医疗机构的督导记录和痰涂片复检质控结果、进行综合分析和评价。结果2007年53家基层综合医疗机构,共登记可疑肺结核症状者21313例,查痰6989例发现涂阳肺结核403例,涂阳检出率5.8％。未查痰病人转至结防机构查痰5972例,发现涂阳肺结核2030例,涂阳检出率34.0％。涂阴病人转至结防机构再查痰3940例,涂阳肺结核893例,涂阳检出率22.7％。结防机构查痰29048例,涂阳9896例,涂阳检出率34.1％,与综合医疗机构比较差异有统计学意义（P<0.05）。结论加强综合医疗机构与结防机构的合作。对综合医疗机构痰涂片检查人员进行业务培训及复训,提高痰检质控质量,保证检出率,以达到提高涂阳病例发现的目的。     

初治痰菌阳性肺结核疗程结束时空洞或结核球内细菌学分析

目的对初治痰菌阳性肺结核病例短程化疗结束后痰菌阴转，但肺内仍存在结核球或空洞病灶的病例，经皮肺穿刺取材进行细菌学检查，评价短程化疗的疗效。方法2002年1月至2004年5月，选择初治痰菌阳性肺结核83例，患者均经过常规抗结核药物（异烟肼、利福平、乙胺丁醇、吡嗪酰胺）短程化疗，疗程末痰涂片及痰培养均为阴性，但肺部X线表现仍存在空洞或结核球，在疗程结束后1个月内，在CT引导下经皮肺穿刺对空洞壁或空洞内容物或结核球取材，进行细菌学检查，并对检查结果进行分析。结果对活检组织均进行涂片及培养检查，痰菌阴转病例中仅75例（90．4％）获得的组织标本阴性结果，8例（9.6％）获得阳性结果（其中3例为涂片阳性、培养阳性；5例为涂片阴性、培养阳性）。药敏试验结果1例对异烟肼、利福平耐药，其余7例为敏感菌株。24个月的随访结果有6例痰菌阳转。结论初治痰菌阳性空洞、结核球肺结核病例的短程化疗后，组织标本细菌学检查阳性结果的8例病例中在2年内有6例出现痰细菌学复发，提示目前普遍采用的肺结核疗效判断标准（痰菌阴转）值得商榷。     

Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis.

At present, further investigations are needed in patients with suspected pulmonary tuberculosis (TB) and either negative sputum smear or without sputum. The aim of the present study was to analyse the yield of bronchoalveolar lavage fluid (BALF) smear and PCR in patients with confirmed pulmonary TB. Patients with a positive culture for Mycobacterium tuberculosis complex in sputum or BALF were analysed over 5 yrs. In total, 90 out of 230 (39%) patients with culture-positive pulmonary TB had a positive sputum smear, and 120 patients underwent bronchoscopy. BALF smear was positive in 56 (47%), BALF PCR in 93 (78%) patients, and BALF smear and/or PCR was positive in 83%. In total, 71 patients who underwent bronchoscopy and had complete clinical records were further analysed. BALF (smear or Mycobacterium tuberculosis complex-PCR) allowed a rapid diagnosis in 10 (59%) out of 17 patients who had a negative sputum smear, and 49 (91%) out of 54 patients without sputum production. Of these 71 patients, 12 (17%) were only culture positive. Rapid diagnosis of pulmonary TB by smear and/or PCR was made in 190 out of 210 patients (90%) in sputum or BALF. In conclusion, combined use of bronchoalveolar lavage fluid smear and Mycobacterium tuberculosis complex-PCR has a good diagnostic yield in patients with sputum smear-negative tuberculosis or without sputum production.     

Detection of Mycobacterium tuberculosis in bronchoalveolar lavage from patients with sputum smear-negative pulmonary tuberculosis using a polymerase chain reaction assay

Abstract The objective of this study was to evaluate the utility of a polymerase chain reaction (PCR) assay in detecting Mycobacterium tuberculosis in bronchoalveolar lavage (BAL) specimens of patients suspected of having active pulmonary tuberculosis (TB) but who were sputum smear-negative. Patients undergoing investigation for suspected pulmonary TB at the University Hospital, Kuala Lumpur, and who were sputum smear-negative underwent fibreoptic bronchoscopy and BAL. One portion of each lavage specimen was submitted for smear examination for acid-fast bacilli and mycobacterial culture and the other portion assayed by PCR for the presence of a 562-base pair DNA segment belonging to the insertion sequence IS986, unique to the M. tuberculosis complex. As controls, lavage specimens from patients with other lung lesions were also similarly tested. The PCR assay gave a positivity rate of 80.9% (55 of 68) compared with 8.8% of smear examination and 7.4% of culture for detecting M. tuberculosis in BAL specimens. The assay was positive in two of 45 BAL specimens from 35 control subjects. The PCR assay was more sensitive than smear and culture in detecting M. tuberculosis in BAL specimens of patients with sputum smear-negative pulmonary TB.     

纤支镜在菌阴肺结核中的应用评估

目的 观察纤支镜在菌阴肺结核诊断中的价值.方法 分析190例入院时痰涂片和PCR分析均为阴性疑诊为肺结核患者的病例资料,从经纤支镜抗酸杆菌涂片的阳性率、PCR检测结核分枝杆菌阳性率、上皮性肉芽肿支气管活检、结核分枝杆菌的培养阳性率等四个方面进行分析.结果 190例病例中,经纤支镜取样的阳性率:42.6％(痰涂片),63.6％(PCR分析),31.2％(肉芽肿支气管活检),54.2％(痰培养),将各种检查手段联合起来,诊断率可以达到85.2％.结论 经纤支镜取样有较高阳性率,可以提供快速明确的结核诊断.     

粗切割针经皮肺活检对肺结核病的诊断价值

目的 探讨粗切割针经皮肺穿刺活检对肺结核病的诊断价值。方法 对38例不同形态肺结核病灶在CT引导下穿刺的阳性率情况，以及穿刺标本不同检查方法的阳性率进行比较分析。结果 总阳性率为86．8％，其中①结节肿块影、斑片影阳性率分别为96．1％、80％，空洞影为57．1％；②穿刺后组织学、抗酸杆菌培养、细胞学、涂片抗酸杆菌的阳性率分别为65．8％、34．2％、33．3％、5．2％。结论 CT下粗切割针穿刺活检对肺结核病是一种诊断准确性较高的检查方法，活检标本采用多种方法检查可提高阳性率。     

应用蛋白芯片技术快速诊断肺结核病的研究

目的评价结核分枝杆菌蛋白芯片在检测临床标本中结核分枝杆菌抗体的应用价值。方法应用结核分枝杆菌蛋白芯片检测117例结核病患者的血清标本、103例肺部其他疾病患者和健康人的血清标本,并与痰涂片镜检法相比较。结果在菌阳肺结核、菌阴肺结核中,结核分枝杆菌抗体芯片检测的阳性率分别是100%(26/26)、49.6%(45/91),在肺部其他疾病患者和健康人中,结核分枝杆菌抗体芯片检测的阴性率是98.1%(101/103)。结论结核分枝杆菌抗体检测蛋白芯片是一种集基因工程技术、芯片技术和免疫学技术的检测一体化的新型结核病快速诊断方法,具有简便、快速、大量、敏感性高和特异性强、检测成本较低的特点,是结核病、尤其是菌阴结核病辅助诊断的有效方法。     

Combined bronchoalveolar lavage and polymerase chain reaction in the diagnosis of pulmonary tuberculosis in smear-negative patients.

SETTING: The polymerase chain reaction (PCR) may be sensitive and specific for the diagnosis of tuberculosis, but most reports are of studies conducted in well-controlled laboratories. A study to evaluate the clinical value of bronchoalveolar lavage (BAL) combined with PCR was necessary. OBJECTIVE: One hundred and thirty one patients were recruited into the study from March 1994 to February 1997. DESIGN: Patients with a positive acid-fast stain on sputum smear were recruited into group A as positive controls, patients with lung cancer and a negative acid-fast stain on sputum smear were put into group B as negative controls, and patients who had clinical symptoms of pulmonary TB without sputum or with negative smear results were the investigating group. PCR was performed on the sputum samples from group A and B patients and on the BAL fluid from those in group C. RESULTS: The sensitivity of PCR was 96% in group A, and the specificity was 100% in group B. The sensitivity of PCR in the BAL fluid from the group C patients was 36% and the specificity was 96%; the positive predictive value was 94% and the negative predictive value was 45%. CONCLUSION: BAL plus PCR is useful in the rapid diagnosis of pulmonary TB in non-productive or smear-negative patients.     

CT引导下肺穿刺活检标本行PCR检测诊断肺结核的临床价值

目的 探讨CT引导下肺穿刺活检标本行PCR检测在肺结核诊断中的价值。方法 回顾性选取2017年1月至2018年3月同济大学附属上海市肺科医院曾疑诊为肺结核、后经病理证实或试验性抗结核治疗确诊的全部111例患者,其中肺结核患者73例(65.8%),非肺结核患者38例(34.2%;包括结节病3例、肺癌17例、隐球菌感染3例、曲菌感染4例、肺脓肿3例、异物肉芽肿2例,支气管扩张症6例)。111例患者均在CT引导下获取肺穿刺活检标本行涂片细胞病理学检查(简称“细胞病理学检查”),其中13例因两次细胞病理学检查不能确诊而行CT引导下粗针肺穿刺活检标本组织病理学检查(简称“组织病理学检查”);上述标本同时采用PCR检测结核分枝杆菌DNA(分别简称为“细胞病理学标本TB-PCR检测”与“组织病理学标本TB-PCR检测”)。以临床最终诊断为标准,探究细胞病理学标本TB-PCR检测诊断肺结核的敏感度、特异度、阳性预测值、阴性预测值、正确指数(一致性),以及组织病理学标本TB-PCR检测的检出效用。采用SPSS 21.0软件对数据进行统计学处理,计数资料采用χ²检验,以P<0.05为差异有统计学意义。 结果 以临床最终诊断为标准,细胞病理学标本TB-PCR检测的敏感度、特异度、阳性预测值、阴性预测值、正确指数分别为83.6%(61/73)、89.5%(34/38)、93.8%(61/65)、73.9%(34/46)、0.73;对肺结核的检测阳性率[83.6%(61/73)]明显高于单一细胞病理学检查[39.7%(29/73)](χ²=29.663,P=0.000)。73例肺结核患者中,13例经组织病理学标本TB-PCR检测阳性者8例,而经细胞病理学标本TB-PCR检测阳性者为12例。另外,肺结核患者中9例(12.3%,9/73)经细胞病理学、组织病理学检查及传统检测方法(痰涂片抗酸染色及痰培养)均未能诊断结核病,经细胞病理学标本TB-PCR检测后有4例阳性。 结论 CT引导下肺穿刺活检标本行TB-PCR检测可提高肺结核诊断的阳性率,具有良好的临床应用价值。