多项无创或低创检查联合对痰菌阴性儿童肺结核的诊断价值

目的 探讨多项无创或低创检查联合[ 肺部CT 扫描、PPD 试验、血沉（ESR）、C- 反应蛋白（CRP）] 对痰菌阴性儿童肺结核的临床诊断价值。方法 回顾性收集269 例肺结核儿童的临床资料，包括痰菌阴性161 例，痰菌阳性108 例，对两组临床特征及多项检查结果进行对比分析。结果 痰菌阴性肺结核儿童临床表现不典型；典型或相对特异的影像学征象较痰菌阳性组少；PPD 试验、ESR、CRP 在菌阴组的阳性率分别为39.1%、44.1%、56.5%，在菌阳组的阳性率分别为55.6%、79.6%、59.3%，两组比较，PPD 试验、ESR 阳性率差异有统计学意义（PP>0.05）。痰菌阴性组中有46 例行支气管镜术，40 例（87.0%）镜下发现有诊断价值的形态改变和（或）获得病原学/病理学诊断依据。结论 对于痰菌阴性儿童肺结核的诊断，联合肺部CT 扫描、PPD 试验、ESR、CRP 多项无创或低创检查可明显提高诊断率；若仍未能提供有力证据时，支气管镜术是十分重要的辅助检查手段。

Values of a combination of multiple less invasive or non-invasive examinations in the diagnosis of pediatric sputum-negative pulmonary tuberculosis

Objective To study the values of a combination of multiple less invasive or non-invasive examinations including chest computed tomography (CT) scan, purified protein derivative (PPD) test, erythrocyte sedimentation rate (ESR) test, and C-reactive protein (CRP) test in the diagnosis of pediatric sputum-negative pulmonary tuberculosis (TB). Methods A retrospective analysis was performed on the clinical data of 269 children with confirmed pulmonary TB. Clinical symptoms and test results were analyzed and compared between the sputum-negative group (161 patients) and the sputum-positive group (108 patients). Results The sputum-negative group had atypical clinical symptoms, with fewer typical or relatively specific imaging features compared with the sputum-positive group. The positive rates of PPD, ESR, and CRP tests for the sputum-negative group were 39.1%, 44.1%, and 56.5%, respectively, versus 55.6%, 79.6%, and 59.3% for the sputum-positive group. There were significant differences in the positive rates of PPD and ESR tests between the two groups (P<0.05). More than 80% of the patients in each group were diagnosed with pulmonary TB according to three or four less invasive or non-invasive tests, without significant difference in the positive rate between the two groups (P>0.05). Forty-six patients in the sputum-negative group underwent bronchoscopy, and morphological changes with a diagnostic value and/or etiological and pathological evidence were observed in 40 (87.0%) of them. Conclusions The diagnosis rate of pediatric sputum-negative pulmonary TB can be increased by combining tests including chest CT scan, PPD test, ESR test, and CRP test. Bronchoscopy is a reliable method for the auxiliary diagnosis of pediatric sputum-negative pulmonary TB if the combining tests cannot provide compelling evidence.