径向超声支气管镜联合快速现场评估在细菌学阴性肺结核诊断中的应用

doi:10.3969/j.issn.1004-583X.2022.03.004

摘要/Abstract

摘要：

目的评估径向超声支气管镜活检(EBUS-GS-TBLB)联合快速现场评估(ROSE)对细菌学阴性肺结核诊断的价值。方法根据临床症状、影像学图像、痰细菌学结果(痰涂片和结核分枝杆菌培养)及首次分子生物学检查结果,收集2020年1月-12月疑似肺结核患者70例,随机分入A组(EBUS-GS-TBLB)34例和B组(EBUS-GS-TBLB+ROSE)36例。评估两组在肺结核的诊断率和取材次数的差异。结果 A组有16例诊断为肺结核,B组有22例。联合ROSE后,肺结核诊断率从47.06%提升到61.11%(P=0.238);平均取材次数从4.53±0.50降低到3.08±0.60(P<0.01);对肺结核诊断的准确度、灵敏度、特异度、阳性预测值和阴性预测值分别是86.36%、86.67%、85.71%、92.86%、75.00%, 同时未出现严重的并发症。结论 EBUS-GS-TBLB联合ROSE可以提高诊断率,减少活检取材次数,是一种有效且安全的新型诊断方式。

关键词: 结核,肺, 径向超声支气管镜, 快速现场评估, 诊断

Abstract:

Objective To evaluate the combination of endobronchial ultrasonography with guide sheath (EBUS-GS), transbronchial lung biopsy (TBLB), and rapid on-site evaluation (ROSE) for the diagnosis of bacteriologically-negative pulmonary tuberculosis (PTB).Methods A total of 70 patients with suspected PTB were enrolled from January 2020 to December 2020 based on clinical symptoms, abnormal radiographic findings, sputum bacteriological examination (smear and culture), and initial sputum molecular detection negative results. The patients randomly divided into two groups: group A underwent EBUS-GS-TBLB (n=34), and group B underwent EBUS-GS-TBLB+ROSE (n=36). The diagnostic rates and biopsy numbers were evaluated between the two groups.Results 16 patients with PTB were detected in group A, and 22 in group B. After the joint ROSE, The PTB diagnostic rate improved from 47.06% to 61.11%(P=0.238), and the mean numbers of biopsy decreased from 4.53±0.50 to 3.08±0.60(P<0.01). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ROSE for the diagnosis of PTB were 86.36%, 86.67%, 85.71%, 92.86%, and 75.00%, respectively, with no serious complications.Conclusion The combination of EBUS-GS-TBLB and ROSE can improve the diagnostic rate, and reduce the biopsy numbers, which is thought of an effective and safe novel diagnostic modality.

Key words: tuberculosis,pulmonary, endobronchial ultrasonography with guide sheath, rapid on-site evaluation, diagnosis

中图分类号:

R521

徐敬然, 李菲菲, 解承鑫, 弓慧, 栾其昀, 李黎. 径向超声支气管镜联合快速现场评估在细菌学阴性肺结核诊断中的应用[J]. 临床荟萃, 2022, 37(3): 220-224.

Xu Jingran, Li Feifei, Xie Chengxin, Gong Hui, Luan Qiyun, Li Li. Application of endobronchial ultrasound transbronchial lung biopsy with guide sheath and rapid on-site evaluation in the diagnosis of bacteriologically-negative pulmonary tuberculosis[J]. Clinical Focus, 2022, 37(3): 220-224.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.03.004

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I3/220

图/表 4

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项目
年龄(岁)	64.06±9.03	63.47±12.37	0.226	0.822
性别[例(%)]
男女	15(44.12) 19(55.88)	19(52.78) 17(47.22)	0.526	0.469
BMI(kg/m²)	22.83±3.51	23.11±3.75	-0.336	0.747
吸烟情况[例(%)]
吸烟不吸烟	12(35.29) 22(64.71)	15(41.67) 21(58.33)	0.300	0.584
ESR(mm/1 h)[例(%)]
0<ESR≤15 ESR>15	10(29.41) 24(70.59)	14(38.89) 22(61.11)	0.697	0.404
T-spot[例(%)]
阳性阴性	18(52.94) 16(47.06)	16(44.44) 20(55.55)	0.505	0.477
临床表现[例(%)]
咳嗽	27(38.57)	24(34.29)	N/A
咳血	12(17.14)	10(14.29)
低热	15(21.43)	14(20.00)
检查时发现	7(10.00)	12(17.14)

项目
年龄(岁)	64.06±9.03	63.47±12.37	0.226	0.822
性别[例(%)]
男女	15(44.12) 19(55.88)	19(52.78) 17(47.22)	0.526	0.469
BMI(kg/m²)	22.83±3.51	23.11±3.75	-0.336	0.747
吸烟情况[例(%)]
吸烟不吸烟	12(35.29) 22(64.71)	15(41.67) 21(58.33)	0.300	0.584
ESR(mm/1 h)[例(%)]
0<ESR≤15 ESR>15	10(29.41) 24(70.59)	14(38.89) 22(61.11)	0.697	0.404
T-spot[例(%)]
阳性阴性	18(52.94) 16(47.06)	16(44.44) 20(55.55)	0.505	0.477
临床表现[例(%)]
咳嗽	27(38.57)	24(34.29)	N/A
咳血	12(17.14)	10(14.29)
低热	15(21.43)	14(20.00)
检查时发现	7(10.00)	12(17.14)

项目	A组 (n=34)	B组 (n=36)	t/χ²值	P值
肺结核人数[例(%)]	16(47.06)	22(61.11)	1.391	0.238
取材次数	4.53±0.51	3.08±0.60	10.348	<0.01
灌洗液的实验室检查[例(%)]
结核分枝杆菌荧光染色
阳性阴性	8(23.53) 26(76.47)	11(30.56) 25(69.44)	0.437	0.509
分子生物学检查
阳性阴性	13(38.24) 21(61.76)	13(36.11) 23(63.89)	0.034	0.854
结核分枝杆菌培养
阳性阴性	7(20.59) 27(79.41)	10(27.78) 26(72.22)	0.491	0.483

项目	A组 (n=34)	B组 (n=36)	t/χ²值	P值
肺结核人数[例(%)]	16(47.06)	22(61.11)	1.391	0.238
取材次数	4.53±0.51	3.08±0.60	10.348	<0.01
灌洗液的实验室检查[例(%)]
结核分枝杆菌荧光染色
阳性阴性	8(23.53) 26(76.47)	11(30.56) 25(69.44)	0.437	0.509
分子生物学检查
阳性阴性	13(38.24) 21(61.76)	13(36.11) 23(63.89)	0.034	0.854
结核分枝杆菌培养
阳性阴性	7(20.59) 27(79.41)	10(27.78) 26(72.22)	0.491	0.483