支气管镜肺泡灌洗基因Xpert MTB/Rif对涂片阴性临床影像学疑似肺结核病例的诊断率

B. Bista, N. Karmacharya, Ram Hari Ghimire, P. Shrestha, D. Poudel, Janer Kurumbang, M. Mahato, Deebya Raj Mishra
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引用次数: 0

摘要

背景:肺结核的早期诊断是困难的,但可怕的并发症,如空化、脓肿、弥漫和肺实质纤维化是可以避免的。痰液镜检仍然是诊断肺结核最有效的方法,但仍有相当数量的活动性病例仅通过这种方法诊断不出来。在痰少或痰镜检查和痰液Xpert MTB/Rif阴性的肺结核患者中,支气管肺泡灌洗可能为Xpert MTB/Rif基因诊断肺结核提供更好的样本。材料与方法:选取痰镜检查及Xpert痰检MTB/Rif阴性的2年以上临床影像学怀疑为肺结核的患者为研究对象。行BAL expert MTB/Rif纤维支气管镜检查。采用SPSS软件17对基线人口统计学、临床和放射学数据进行系统分析。结果:64例患者入组,平均年龄41±10.52岁。最常见的症状为咳嗽、咳痰和体重减轻,分别为58例(90.6%)、31例(48.4%)和21例(32.11%)。最常见的CT表现为实变、空化和树状芽状。BAL Xpert MTB/Rif阳性11例(17.18%)。根据BAL expert的CT结果,MTB/Rif最常见于出现空洞性肺病的患者。结论:64例痰液稀少或镜检和痰液Xpert/Rif基因均阴性的患者中,11例BAL基因Xpert/Rif阳性。支气管镜BAL Xpert/Rif可以为这些患者提供额外的诊断测试。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnostic Yield of Bronchoscopic Alveolar Lavage Gene Xpert MTB/Rif in Smear Negative Clinico-Radiologically Suspected Case of Pulmonary Tuberculosis
Background: Early diagnosis of pulmonary tuberculosis is difficult but dreaded complications like cavitations, abscess, disseminations and fibrosis of lung parenchyma can be avoided. Sputum microscopy is still the most available test for diagnosis of pulmonary tuberculosis but sustainable number of active cases remains undiagnosed via this method alone. In strong clinico-radiological pulmonary tuberculosis patients who are sputum scarce or sputum microscopy and sputum Xpert MTB/Rif negative broncho-alveolar lavage may provide superior sample for Gene Xpert MTB/Rif in diagnosis of Pulmonary Tuberculosis. Materials and Methods: Over 2 years period, patients with strong clinico-radiological suspicion of pulmonary tuberculosis who had sputum microscopy and sputum Xpert MTB/Rif negative were included in the study. Fibro-optic bronchoscopy was done for BAL Xpert MTB/Rif test. Base line demographic, clinical and radiological data were systematically analysedby SPSS software version 17. Results: 64 patients were included in the study with mean age 41 ± 10.52 years. The most common symptoms were cough, sputum production and weight loss with frequency of 58 (90.6%), 31 (48.4%) and 21 (32.11%) patients respectively. The most common CT scan findings were consolidation, cavitation and tree in bud pattern. BAL Xpert MTB/Rif was positive in 11 (17.18%) patients. According to the CT findings BAL Xpert MTB/Rif was most commonly present in patients presenting with cavitary lung disease. Conclusion: Eleven patients had BAL gene Xpert/Rif positive out of 64 patients who were sputum scarce or had both microscopy and sputum gene Xpert/Rif negative. Bronchoscopy BAL Xpert/Rif could provide an additional diagnostic test in these groups of patients.  
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