Computed tomographic findings in female genital tuberculosis tubo-ovarian masses

Female genital tuberculosis (FGTB) is a common cause of infertility in developing countries. It can manifest as menstrual disturbances, infertility and pelvic masses.ObjectiveTo evaluate the role of computed tomography in diagnosis of female genital tuberculosis with tubo-ovarian (adnexal) masses.MethodsIt was a prospective study over a four year period (July 2015 to August 2019) in a tertiary referral centre over 33 patients presenting with tuberculosis and tubo ovarian masses only. 75 total cases of FGTB diagnosed on composite reference standard (evaluation of AFB bacilli in microscopy or culture or endometrial biopsy, gene expert, epitheloid granulomas on endometrial biopsy or definitive or possible findings of FGTB on laparoscopy). Detailed history taken, clinical examination, baseline investigations and endometrial biopsy were done in all cases. Computed tomography was performed in women presenting with infertility, tubo ovarian masses on clinical examination and laboratory investigations. A total of 33 cases were evaluated.ResultsMean age, body mass index, parity and history of TB contact were 27.5 ± 4.2 year, 22.7 ± 3.6 kg/m², 0.27 ± 0.13 and 44.4% respectively. Infertility was primary in 72.72% and secondary in 27.23%. Case wise mean duration being 5.8 years, menstrual dysfunction was seen in 45.45% cases. Abdominal discomfort with pain and lump were seen in all 33 (100%) cases. Abdominal lumps were felt in 4 (12.12%) cases while adnexal mass was seen in all 33 (100%) cases being unilateral in 18 (54.54%) and bilateral in 15 (45.45%). Mean ESR was 33.4mm in first hour while mean leucocyte count was 6128 ± 2854 per cubic mm. Infectious mantoux test (>10mm) was seen in 14 (42.82%) cases while abnormal X ray chest was seen in 9 (27.27%) cases.Diagnosis of FGTB was made by positive AFB n microscopy or culture of endometrial biopsy in 5 (15.15%) cases, positive gene expert in 6 (18.18%) cases, positive polymerase chain reaction in 32 (96.96%) cases, epitheloid granulomas on histopathology of endometrial biopsy in 7 (21.21%) cases, definitive findings of tuberculosis in 15 (45.45%) cases and a possible findings of tuberculosis inn 18 (54.54%) cases. Various CT findings were pelvic mass (100%), unilateral pelvic mass in 18 (54.54%), bilateral pelvic mass in 15 (45.45%), cystic mass (24.2%), solid mass (21.2%), mixed mass (54.54%), mass showing multilocular caseous necrotic enhancements (12.12%), ascites (42.4%), thickening and enhancement of peritoneum in 14 (42.42%), nodules in 24.2%, smooth in 18.8%, pelvic adhesion in 6 (18.18%), lymphadenopathy in 8 (24.3%) with calcifications (9.09%) and central necrosis (52.5%). Other CT findings were thickening and enhancement of bowel wall (12.12%), hepatic TB (3.03%), splenic TB (3.03%), omental thickening (9.09%) and omental calcification (3.03%) cases.ConclusionComputed tomography appears to be a useful diagnostic modality in diagnosis of tuberculosis tubo ovarian masses and may help avoid unnecessary surgery.     

Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study

Study objectiveTo evaluate the hysteroscopic findings in female genital tuberculosis.DesignIt was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB).SettingIt was a prospective cross-sectional study in a tertiary referral centre.PatientsA total of 348 patients with infertility with FGTB on various tests.InterventionA total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings.Measurements and main resultsThe mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m² and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation.ConclusionHysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.     

血清CA125检测对绝经后子宫内膜癌的临床应用价值

目的探讨血清CA     

Sharma's parachute sign a new laparoscopic sign in abdomino pelvic tuberculosis

AimsTo demonstrate a new laparoscopic sign “Sharma's Parachute sign” in abdominopelvic tuberculosis in women with infertility.MethodsA total of 104 women who were diagnosed to have abdominopelvic tuberculosis, on endometrial sampling or on laparoscopy were enrolled in this ongoing study on tuberculosis in infertility. A new laparoscopic “Sharma's parachute sign” was looked for in these cases on laparoscopy.ResultsThe mean age, pairty and duration of infertility was 27.6 years, 0.58 and 4.1 years respectively. Menstrual dysfuction were common especially hypomenorrhoea (34.61%), oligomenorrhoea (36.53%) along with constitutional symptoms and abdomino pelvic pain or lump. Diagnosis of abdominopelvic tuberculosis was made by identification of acid fast bacilli (AFB) on microscopy or culture of endometrial aspirate or peritoneal biopsy or positive gene Xpert or positive polymerase chain reaction (PCR) or histopathological demonstration of epithelioid granuloma on endometrial or peritoneal biopsy, various laparoscopic findings on pelvic and abdominal organs were tubercles and shaggy areas (white deposits, caseous nodules encysted ascites, abdominal and pelvic adhesions, tubal findings (hydrosalpinx, pyosalpinx, beaded or calcified tubes). A new “Sharma's parachute sign”in which ascending colon was totally adherent to anterior abdominal wall with its mesocolon looking like an open parachute with small caseous nodule was seen in 11 (10.5%) cases.ConclusionDiagnostic laparoscopy is an important investigation for abdominopelvic tuberculosis showing various adhesions including new parachute sign.     

Role of microbiological tests in diagnosis of genital tuberculosis of women with infertility: A view

ObjectiveIndia is a country sharing one fourth of the global incidence of tuberculosis. It is much easier to diagnose pulmonary cases, but challenges are with extrapulmonary cases. Genital tuberculosis is considered as an important cause of infertility in young females in India and difficult to diagnose. It requires incorporation of different modalities that should correctly, timely and rapidly diagnose the case.MethodsThis study was conducted retrospectively for a period of 12 months on 438 endometrial samples from females with history of infertility. Three modalities namely Ziehl-Neelsen staining, Automated liquid culture and Nucleic acid amplification technique (TB-PCR) were compared and their sensitivity in diagnosis of genital tuberculosis was ascertained.ResultsOut of 438 samples, 18 samples were found positive with at least one modality. TB-PCR positivity was 3.6% (16 cases) in comparison to culture where positivity was 1.59% (7 cases). Five samples were found culture and TB-PCR positive and only one sample was positive by all three diagnostic tests.ConclusionInfertility in young female per se is usually heart breaking and distressing. Therefore, it is essential to diagnose and treat the cases of genital tuberculosis before irreversible damage of tube may happen. Although, advancement in diagnostic field is there from microscopy to molecular method, but still diagnosis of genital tuberculosis is challenging. Correct diagnosis prevents young female from mental trauma and toxicity of anti-tuberculosis drugs given on suspicion in high prevalence country like India.     

Tuberculous peritonitis in Egypt: the value of laparoscopy in diagnosis.

Abdominal laparoscopy was performed on 200 patients with undiagnosed ascites. It was unsuccessful in one patient with tuberculous peritonitis because of extensive adhesions. A presumptive diagnosis of tuberculous peritonitis based on clinical findings and peritoneal tubercles or adhesions visualized during laparoscopy was made in 90 of these patients. The diagnosis was confirmed in 88 by histopathology, bacteriology, or therapeutic response. Two of the 109 remaining patients who had other presumptive diagnoses made during laparoscopy were eventually confirmed to be cases of tuberculous peritonitis. Of 91 patients with tuberculous peritonitis included in this series, 79% were females, with the majority (79%) of them being of child-bearing age. Half had been ill for longer than one month. The most frequent complaints were abdominal pain, fever, anorexia, night sweats, abdominal swelling, and weight loss. Ascites, fever, wasting, pallor, and abdominal tenderness were common findings. Ultrasonography demonstrated ascites in all patients who underwent this procedure; 21% also had adhesions. Pleural effusion was present in 15% and pulmonary tuberculosis was detected in only two patients. Biopsy samples taken during laparoscopy showed that 60% had noncaseous granulomas and 33% had caseous granulomas. Mycobacterium tuberculosis was detected in 77%, with guinea pig inoculation having the highest sensitivity, followed by culture, and lastly by acid-fast smear. Mycobacterium tuberculosis was isolated more easily from biopsy samples than from ascitic fluid. Nine of 20 M. tuberculosis isolates that were identified as to species were M. bovis. Tuberculous peritonitis, a frequent cause of febrile ascites in Egyptian women, was easily diagnosed by histopathologic and bacteriologic studies of biopsy samples taken at laparoscopy. All patients responded rapidly to antituberculosis therapy.     

Atypical peritoneal tuberculosis. Use of laparoscopy in the diagnosis]

The presence of peritoneal tuberculosis has to be clinically suspected in all patients with abdominal pain of unknown etiology, particularly when it is accompanied by fever, ascites, and abdominal distension. Access to the abdominal cavity using routine laparoscopy provides essential information on the diagnosis, from both macroscopic images and biopsy sampling, which will later provide a pathological and microbiological confirmation. This helps discriminate between potential differential diagnoses that may include similar symptoms. Other laboratory tests have to be considered as diagnostic aids, as well as for the indication of laparoscopy, including ADA, and Gallium-67 or Ca-125 scans.     

Polymerase chain reaction of pleural biopsy is a rapid and sensitive method for the diagnosis of tuberculous pleural effusion

BACKGROUND: Tuberculous pleural effusion occurs in 30% of patients with tuberculosis (TB). Rapid diagnosis of a tuberculous pleural effusion would greatly facilitate the management of many patients. Polymerase chain reaction (PCR) has been used to detect Mycobacterium tuberculosis in pleural fluid with highly variable sensitivity. OBJECTIVE: To improve our laboratory diagnosis of tuberculous pleural effusion. METHODS: We applied PCR to detect DNA specific for M tuberculosis in 33 of the studied pleural biopsy specimens using an IS986-based primer that was specific for mycobacterium complex, and compared it to the results of pleural fluid and biopsy cultures performed on either Lowenstein-Jensen (LJ) medium or BACTEC 12B liquid medium (Becton Dickinson Microbiology Systems; Cockeysville, MD), Ziehl-Neelsen (ZN) staining, and histopathology in 45 patients with pleural effusion. RESULTS: Of the 45 patients with pleural effusion who were studied, 26 patients received diagnoses of tuberculous pleural effusion that had been confirmed by either culture and or histopathology, 10 patients received diagnoses of exudative effusion due to causes other than TB, and 9 patients received diagnoses of transudative effusion. Histopathology of the pleural biopsy specimen had a sensitivity of 53.8%. The sensitivity of the ZN staining of pleural fluid and biopsy specimens was 0.0% and 3.8%, respectively. The sensitivity of the culture on both BACTEC 12B liquid medium and LJ medium was higher in pleural biopsy specimens (92.3%) than in pleural fluid specimens (15.4%; p > 0.001). The improvements of the BACTEC culture system improved and shortened the detection time of M tuberculosis in pleural biopsy specimens. PCR of pleural biopsy specimens had 90% sensitivity and 100% specificity. The positive predictive value and the negative predictive value for pleural biopsy specimen cultures were 100% and 90.5% vs 100% and 86.7% for pleural biopsy specimen PCRs. CONCLUSION: The overall accuracy of PCR of pleural biopsy was similar to the results of pleural biopsy culture, however, PCR of the pleural biopsy was much faster in reaching diagnosis. PCR of pleural biopsy is a useful method when used in combination with the BACTEC culture system and histopathologic examination of pleural biopsy to reach a rapid diagnosis of tuberculous pleural effusion.     

CA125在肺结核、结核性胸膜炎与肺癌鉴别诊断中的价值

目的讨论CA125测定在肺结核、结核性胸膜炎与肺癌鉴别诊断中的价值。方法对27例菌阳肺结核、21例结核性胸膜炎及18例肺癌患者的血清CA125进行检测,同时检测其他11项肿瘤标记物的血清浓度（如CEA、CA199、CA242等）,对以上3组的检测结果进行分析。结果结核性胸膜炎组血CA125浓度（75.43±28.74KU/L）高于肺癌组（42.09±16.41KU/L）及肺结核组（23.26±7.59KU/L）,统计学有显著性差异（P〈0.05）。肺癌组CA125高于肺结核组,两组比较有显著性差异（P〈0.05）。其他肿瘤标记物阳性率：肺癌组（38.9%）高于肺结核组（3.7%）和结核性胸膜炎组（4.76%）,差异有显著性（P〈0.05）。结论血CA125检测在肺结核及肺癌鉴别诊断中有重要的临床价值,结合肿瘤标记物其他项目的检测结果及动态观察CA125浓度的变化更有利于明确诊断。     

Tuberculous peritonitis of the wet ascitic type: clinical features and diagnostic value of image-guided peritoneal biopsy

BACKGROUND: Abdominal tuberculosis is still a medical problem in developing countries. AIMS: To analyse the clinical, laboratory, ultrasonography and computed tomography findings and to discuss the diagnostic approach of 19 patients with peritoneal tuberculosis. PATIENTS: Nineteen patients diagnosed in our department, with peritoneal tuberculosis (8 female, 11 male; mean age: 47.89 +/- 4.3 years) between 1996 and 2002, were studied retrospectively. METHODS: All clinical, laboratory, radiological findings, and diagnostic methods were reviewed. RESULTS: The most common symptoms and signs of the disease in these patients were abdominal pain, ascites, weight loss and night sweats. On conducting skin test, eight patients (42%) were found to be positive, while all the patients had elevated serum cancer antigen 125 levels, but acid-resistant bacilli could not be demonstrated on the direct preparation. In three patients (15.78%), the ascitic fluid culture was positive. The most common ultrasonographic and computed tomographic findings were ascites, septation in the ascites, peritoneal thickening, mesenteric and omental involvement. An abnormal chest X-ray, suggestive of previous tuberculosis was present in three patients. Diagnosis was made by image-guided percutaneous peritoneal biopsy in 18/19, and by histological examination of biopsy specimens obtained via laparoscopy in 1/19. Laparoscopy was only performed in 1 of the 19 patients due to lack of sufficient material for histological diagnosis by percutaneous biopsy. Of the biopsy specimens, 84% revealed caseating granulomas, while 16% were non-caseating. Acid-fast bacilli were seen on the Ziehl-Neelsen stain in 18 patients. CONCLUSIONS: Peritoneal tuberculosis should be considered in the differential diagnosis of exudative ascites. Image-guided percutaneous peritoneal biopsy seems to be a sufficient, safe and inexpensive method for diagnosis of peritoneal tuberculosis.     

联合检测血清CEA、CA125、FERRI、NSE在肺癌诊断中的应用价值

目的研究血清CEA、CA125、FERRI、NSE的检测在肺癌诊断中的临床意义。方法采用ELISA方法测定76例肺癌患者血清CEA、CA125、FERRI、NSE的水平,并检测20例非肿瘤患者组进行比较。结果 CEA、CA125、FERRI、NSE的联合检测的阳性率达到84.2%,明显高于各单项标记物的检测阳性率（分别为42.7%、34%、36%、38%）。Ⅲ＋Ⅳ期患者CEA、CA125、FERRI、NSE的阳性率明显高于Ⅰ＋Ⅱ期患者。CEA和CA125在腺癌患者中阳性率较高。NSE在小细胞癌患者中阳性率较高。FERRI在Ⅲ＋Ⅳ期患者中阳性率较高。肺癌患者中四种标记物的阳性率明显高于非肿瘤患者。结论 4项肿瘤标志物CEA、CA125、FERRI、NSE对肺癌的诊断都有一定意义。4项肿瘤标志物的水平与临床分期和病理类型密切相关。联合检测可提高诊断率。     

La tuberculose péritonéale: étude rétrospective de 61 cas à l’hôpital Principal de Dakar

Aims

To describe the characteristic features (epidemiological, clinical, paraclinical, therapeutic and evolutive) of peritoneal tuberculosis in Senegal.

Patients and methods

Retrospective study, which included all cases of peritoneal tuberculosis identified at Principal hospital in Dakar between the 1 January 1996 and 30 June 2006.

Results

Sixty-one cases of peritoneal tuberculosis were included in ten years and six months. The mean age of patients was 36 years, and the sex ratio was 0.9. Ascites associated with fever was the most common symptom. The ascitic fluid was exudative in 92.4% and lymphocytic in 90.5%. Peritoneal tuberculosis was isolated in 70.5% of cases and associated with pleural effusion in 21%, lung involvement in 13% and liver involvement in 3.2%. The HIV was positive in 4.5% of patients who were tested. The definite diagnosis was based on laparoscopy associated with peritoneal biopsy showing granulomatous lesions in 70% of cases. The outcome was favourable in all cases after antituberculous therapy.

Conclusion

Peritoneal tuberculosis occurs in young adult with a discrete female predominance in this series. It must be suspected in the presence of any lymphocytic and exudative ascites associated with fever. The definite diagnosis is based on laparoscopy with peritoneal biopsy. The outcome is generally favourable with antituberculous treatment.     

联合检测血清EMAb及CA—125在子宫内膜异位症中的应用

分别采用酶联免疫吸附法（ＥＬＩＳＡ）及放射免疫法测定了１５９例子宫内异位症（内异症）患者（内异症组）血清子宫内膜抗体（ＥＭＡb）及卵巢上皮癌相关抗原（ＣＡ－１２ ５）水平,并与正常对照组比诊断内异症的敏感性为６４．１５％,特异性为９２．５０％;单独测定ＣＡ－１２５的敏感性为８１．１３％,特异性为９７．５０％。如以ＥＭＡb 及ＣＡ－１２５均阳性为诊断标准,则诊断内异症的敏感性为５４．００％,特异性为１０     

Clinical picture of genital tuberculosis in different forms of its pathogen

Improvement of bacteriological diagnosis is of great value for the clinical picture of genital tuberculosis. The purpose of the study is to reveal the clinical features of genital tuberculosis in L-forms of Mycobacterium tuberculosis (MBT) versus traditional bacteriological methods and polymerase chain reaction (PCR) test with MBT DNA. A hundred and fourteen patients with verified active genital tuberculosis were examined. They were divided into 3 groups: 1) 36 patients with L-forms of MBT in the endometrial scrapes; 2) 32 with bacteriologically verified GT; 3) 46 with positive PCR test. A control group (Group 4) comprised 120 patients with NGD. Among the patients with L-forms there were prevalent females aged 21-40 years (83.4%). These patients had a history of spontaneous abortions more frequently than patients from other groups, in a third was found to have MBT with their L-variants. Signs of intoxication were observed in 47.2%. Oviductal obliteration and specific changes typical of tuberculosis were revealed on a hysterogram in 63.9%, other forms of prior and current extragenital tuberculosis were detected in a half of cases, traces of prior pulmonary tuberculosis were observed in 15%, 63.9% of the patients with L-forms and in 87% of those with positive PCR test were found to have pathological changes in the endometrium, which is indirectly indicative of its lesion. Thus, detection of L-forms of MBT in the endometrial scrapes leads to the conclusion that this is an active sluggish hematogenic tuberculous process, which is evidenced by a complex clinical and laboratory study.     

Fiberbronchoscopy in smear-negative miliary tuberculosis

Twenty-two patients with smear-negative miliary tuberculosis underwent fiberbronchoscopy and brush smears; bronchial aspirates and transbronchial lung biopsy specimens were obtained. A definite diagnosis of tuberculosis was made in 16 (73 percent) patients. A rapid diagnosis was established in 14 of these 16 patients either from brush smears alone (three) or bronchial aspirate smear alone (one) or exclusively by histopathologic study of biopsy specimens (seven). Both brush smears and biopsy histopathology results provided the diagnosis in three patients. Bronchial aspirate culture was the only positive specimen in two patients. No serious complication resulted from the procedure. Our experience substantiates previous reports of the value and safety of fiberbronchoscopy in the rapid diagnosis of smear-negative miliary tuberculosis.     

Role of GeneXpertMTB/RIF in the diagnosis of cutaneous tuberculosis

Backgroundcutaneous involevemtn is an important extrapulmonary manifestation of tuberculosis. It is a paucibacillary condition and has diverse clinical presentations. Sufficient data is not available regarding role of GeneXpertMTB/RIF in cutanoues tuberculosis.Methodsin this study, BacT/Alert3D and response to antitubercular therapy were taken as gold standard and performance of GeneXpertMTB/RIF was evaluated against it in clinically and histopathologically suspected cases of cutaneous tuberculosis.Resultsforty seven patients were included in the study of which commonest presentation was scrofuloderma (42.6%) followed by lupus vulgaris (40.4%). Granulomatous inflammation on histopathology was seen in 75.5% patients on skin biopsy. Sic patients had extracutaneous focus of tuberculosis. In 14 (29.79%), culture of skin biopsy was positive for M. tuberculosis and all showed complete response to ATT in 6 months. GeneXpertMTB/RIF detected M. tuberculsois in 4 samples.ConclusionGeneXpertMTB/RIF is not a reliable tool for diagnosis of cutaneous tuberculosis. Clinic-histopathological correlation along with response to ATT is needed for confirmation of diagnosis of cutaneous tuberculosis.     

Peritoneal tuberculosis in the Fes University Hospital (Morocco). Report of 123 cases

AIMS: Peritoneal tuberculosis is an important public health issue in Morocco. Our aim was to describe the clinical, biological, and therapeutic features of peritoneal tuberculosis treated in a University Hospital in Morocco. PATIENTS AND METHODS: We retrospectively included 123 patients with peritoneal tuberculosis diagnosed at the gastroenterology unit of the Fes University Hospital between January 2001 and August 2003. RESULTS: The mean age was 28 years with a clear female predominance (sex ratio 2.61). Ascites associated with fever were the most frequent signs found in 80.5% of patients. The ascitic fluid was exsudative in 90% of cases and lymphocytic in 88%. The diagnosis was based on laparoscopy or laparotomy with peritoneal biopsy demonstrating caseating granulomatous lesions in 92.4% of patients. Patients were given antituberculous therapy for 6 months, and the outcome was favourable in 90%. CONCLUSION: Peritoneal tuberculosis is very frequent in Morocco, where the diagnosis is based exclusively on peritoneal biopsies obtained during laparoscopy. With an adapted treatment, the course of the disease is favourable in most cases.     

CA125,CA19—9检测在卵巢癌诊断及治疗中的价值

应用酶联免疫（ＥＬＩＳＡ）方法进行ＣＡ１２５、ＣＡ１９－９检测,结果显示ＣＡ１２５在卵巢术前患者中灵敏度为８７．５％,特异度为９０％,准确率为８８．７１％,明显高于其它疾病;卵巢癌术后ＣＡ１２５数值明显下降,与术前相比有显著性差异;ＣＡ１２５与ＣＡ１９－９联检可提高卵巢癌检出率。     

综合医院住院肺结核诊断现状分析

目的了解分析综合医院住院活动性肺结核患者的诊断现状。方法对2002年1月1日—2006年5月31日北京大学人民医院控感科登记的以“肺结核”为主要诊断出院的患者住院病历进行调查并进行回顾性分析,不包括陈旧性肺结核及结核性胸腔积液。结果共统计分析患者74例,其中呼吸内科报告最多,共53例(71.6%),其次为胸外科,共13例(17.6%)。有典型结核中毒症状者仅31例(41.9%),红细胞沉降率明显增快患者者占54.1%,PPD试验阳性仅54.1%。查痰率64.9%,涂阳率54.2%。患者入院至确诊时间平均为13.15 d,≤14 d者48例(64.9%),>14d者26例(35.1%)。确诊方法主要为痰抗酸杆菌阳性(共26例,占35.1%)。经各种活检确诊共27例(36.7%),其中纤维支气管镜下活检诊断8例(10.9%),经开胸肺活检确诊17例(23.0%),经肺穿刺活检确诊1例(1.4%),淋巴结活检确诊1例(1.4%),除纤维支气管镜下活检阳性率88.9%外,其余方式活检阳性率均为100%。临床诊断20例(27.0%)。结论综合医院呼吸内科处于结核病防治的第一线,目前北京大学人民医院对大部分肺结核患者在住院2周之内确诊。主要诊断方法仍为痰找抗酸杆菌阳性,但相当一部分患者通过各种方式的活检确诊。今后应进一步提高痰菌检查率和阳性率。对于诊断不清的病例应及时进行纤维支气管镜检查(包括镜下活检),必要时行肺穿刺甚至开胸肺活检。     

28例AIDS合并肺部疾病病人的支气管镜检查结果分析

目的评估支气管镜检查对艾滋病（AIDS）病人合并肺部疾病的应用价值。方法分析28例AIDS合并肺部疾病病人的临床表现、胸部CT、支气管镜下表现、支气管肺泡灌洗液（BALF）检验结果、经支气管肺活检病理结果。结果 28例病人的BALF结果：涂片革兰染色G＋球菌阳性8例,G-杆菌阳性3例;涂片查抗酸杆菌阳性1例;涂片查真菌孢子及菌丝全阴性;人类巨细胞病毒脱氧核糖核酸（HCMV DNA）阳性14例;结核分枝杆菌脱氧核糖核酸（TB DNA）阳性5例;细菌培养铜绿假单胞菌4例,肺炎链球菌1例,烟曲霉菌2例,白色念珠菌1例。支气管肺活检组织病理：鳞癌3例,小细胞癌1例,肉芽肿性炎1例。根据支气管镜检查结果分为肺癌组（4例）、肺结核组（10例）、其他病原体感染组（14例）。经Kruskal-wallis检验,3组病人CD4＋T淋巴细胞计数之间差异有统计学意义（P=0.016）。结论支气管镜检查可显著提高AIDS病人各种肺部疾病的病因诊断率,而且不受病人免疫功能缺陷的影响,具有较高的应用价值。