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。

Bacteriological examination on needle biopsy specimens of cavity and tuberculoma after a short course chemotherapy in initially sputum positive pulmonary tuberculosis patients

Objective To evaluate the therapeutic effect of a short course chemotherapy on initially sputum positive cavitary pulmonary tuberculosis or tuberculoma by bacteriological examination of specimens through percutaneous lung biopsy after the chemotherapy.Methods Eighty-three cases of initially sputum positive pulmonary tuberculosis with cavities or tuberculoma were included from Jan.2002 and May.2004.The patients finished a course of chemotherapy(2HREZ/4HR),and the sputum was converted to smear-negative and culture-negative,but cavities or tuberculoma remained on the chest X-ray.Lung specimens were obtained from the wall or content of the cavity or from the tuberculoma by CT-guided percutaneous lung biopsy for bacteriological examination within one month after the course.Results All the needle biopsy specimens were smeared and cultured for Mycobacterium tuberculosis.Eight cases(8/83,9.6%)showed positive results:3 were smear-positive and culture-positive,and 5 smear-negative but culture-positive.Drug susceptibility test showed that 7 of them were drug-sensitive and the remaining 1 was resistant to rifampin and isoniazid.After follow-up of 24 months,6 of them converted to sputum smear-positive.Conclusion Our study showed that 90.4%(75/83)of the tuberculosis cases achieved real bacteriological negative result on biopsies after a short course chemotherapy,and the bacteriological positive cases on biopsy experienced 75.0%(6/8)sputum bacteriological recurrence.The result suggests that the evaluation criteria with sputum on therapeutic effect of pulmonary tuberculosis needs to be reassessed.