支气管内超声引导下经支气管针吸活检诊断胸内结核  

The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of intrathoracic tuberculosis

作　　者：孙加源[1] 滕家俊[2] 钟润波[2] 李志夫[3] 张杰[4] 赵珩[5] 韩宝惠[2] 

机构地区：[1]上海交通大学附属胸科医院内镜室,200030 [2]上海交通大学附属胸科医院呼吸内科,200030 [3]上海交通大学附属胸科医院检验科,200030 [4]上海交通大学附属胸科医院病理科,200030 [5]上海交通大学附属胸科医院胸外科,200030

出　　处：《中华胸心血管外科杂志》2014年第11期653-656,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市级医院新兴前沿技术项目（SHDC12010101）;上海市卫生局项目（20124270）;上海市科委科研计划项目（134119a6001）

摘　　要：目的 评价支气管内超声引导下经支气管针吸活检（EBUS-TBNA）对胸内结核的诊断价值.方法 回顾性分析2009年10月至2013年3月上海市胸科医院行EBUS-TBNA检查,最终确诊为胸内结核患者的资料,观察EBUS-TBNA对胸内结核病理学和微生物学诊断效果和安全性.结果 75例患者确诊为胸内淋巴结结核或肺结核,EBUS-TBNA诊断率为80％（60/75）,其中完整行EBUS-TBNA病理、抗酸染色和分支杆菌培养检查的60例患者中,EBUS-TBNA诊断52例,诊断率86.67％;病理发现支持结核诊断者77.33％ （58/75）,抗酸染色涂片阳性率20.31％ （13/64）,培养阳性率46.67％ （28/60）;75例患者穿刺淋巴结129组,肺内肿块10个,平均1.85组（个）/例,病理显示结核表现者66.19％ （92/139）,抗酸染色涂片阳性率13.91％ （16/115）,培养阳性率38.32％ （41/107）.多因素回归分析发现阳性病理、涂片、培养均与病灶的短径大小呈正相关,阳性病理又与穿刺次数呈正相关,病理显示坏死和抗酸染色涂片阳性者的培养阳性率更高.结论 EBUS-TBNA是诊断胸内结核的一种安全、有效方法.Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle biopsy （EBUS-TBNA） in intrathoracic tuberculosis（TB）.Methods We retrospectively analyzed patients underwent EBUS-TBNA with a final diagnosis of intrathoracic TB at Shanghai Chest Hospital from October 2009 to March 2013 and observed that the diagnostic efficacy by pathology and microbiology and safety of EBUS-TBNA for intrathoracic TB.Results 75 patients were diagnosed with pulmonary TB or intrathoracic tuberculous lymphadenitis,and accuracy was 80% （60/75） by EBUS TBNA.A total of 60 patients had pathology,acid-fast bacilli（AFB） staining and mycobacterial culture test results,of whom 52 （86.67%）were diagnosed.Pathological findings were consistent with TB in 77.33% patients （58/75）,in 20.31% （13/64） the smear were positive for AFB and in 46.67% （28/60） were positive for cuhure.One hundred and twenty-nine mediastinal or hilar lymph nodes and 10 intrapulmonary lesions were biopsied in 75 patients,the average target number of per patient were 1.85.Pathological findings were consistent with TB in 66.19% samples（92/139）,in 13.91% （16/115） were positive for AFB and in 38.32% （41/107） were positive for culture.Multivariate regression revealed that short-axis diameter was an independent risk factor associated with positive pathology,smear and euhure.Additionally,more aspiration times cause higher pathology positive rate,pathology showing necrosis and positive smear were independent risk factors associated with positive cuhure.There were two patients occurred complications during operation.Conclusion EBUS-TBNA was a safe and effective method for the diagnosis of intrathoracic tuberculosis.

关 键 词：支气管内超声 经支气管针吸活检 结核 

分 类 号：R52[医药卫生—内科学]