经纤维支气管镜单套管保护性毛刷采样病原菌培养对支气管-肺真菌感染致慢性阻塞性肺疾病急性加重的诊断价值  

Diagnostic Value of Quantitiative Culture Sampled from Bronchoscopic Single Casing Protected Specimen Brush in Bronchial-Pulmonary Fungal Infection in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

作　　者：谭晓明[1] 吴奇涵[2] 叶俊[3] 郑宇[1] 范碧君[1] 郑清[1] 康军[4] 闫泽敏 蒋捍东[1] 

机构地区：[1]上海交通大学医学院附属仁济医院呼吸科,上海200071 [2]华东师范大学生命科学院遗传研究所,上海200013 [3]第二军医大学附属长征医院呼吸科,上海200001 [4]上海交通大学医学院附属仁济医院检验科,上海200071 [5]第二军医大学附属长征医院检验科,上海200001

出　　处：《中国呼吸与危重监护杂志》2014年第6期541-545,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨经纤维支气管镜(简称纤支镜)单套管保护性毛刷采样病原菌培养对于支气管-肺真菌感染所致慢性阻塞性肺疾病(简称慢阻肺)急性加重的诊断价值及安全性。方法选择2011年1月至2012年12月上海仁济医院和长征医院呼吸科收治住院的符合入选标准的73例慢阻肺急性加重患者进行回顾性分析,所有患者均进行经纤支镜单套管保护性毛刷病原菌采样培养(PSB-QC)和肺泡灌洗液真菌培养(BAL-QC),比较两种方法诊断支气管-肺真菌感染的敏感性和特异性。同时分析入选患者纤支镜检查中指脉氧饱和度、心率和血压变化及不良事件发生率以评估其安全性。结果 PSB-QC和BAL-QC诊断技术具有相似的准确度,两组在分离优势病原菌、真菌构成比、诊断敏感性、特异性方面比较均无明显差异(2<3.84,P>0.05)。两者完全一致性为92.5%。在各诊断分组中,确诊组诊断阳性率为22.2%和12%(2=0.948,P>0.05)。所有病例在纤支镜检查操作过程中均未发生严重并发症和死亡。总不良反应发生率BAL-QC组高于PSB-QC组,两组比较差异有统计学意义(2=28.57,P<0.05)。结论在慢阻肺急性加重患者中应用经纤支镜单套管保护性毛刷采样方法是一种安全、简便、易被患者接受的微创技术,采样病原菌真菌培养能为支气管-肺真菌感染与定植提供一定病原学诊断依据,具有一定的临床应用价值。Objective To evaluate the diagnostic value and safety of quantitiative culture（ QC）sampled from bronchoscopic single casing protected specimen brush（ PSB） in bronchial-pulmonary fungal infected acute exacerbation of chronic obstructive pulmonary disease（ AECOPD）. Methods A retrospective study was carried on 73 AECOPD patients who met the inclusion criteria from respiratory departments of Renji Hospital and Changzheng Hospital,Shanghai from January 2011 to December 2012. Pathogenic quantitiative culture was conducted sampling from bronchoscopic PSB（ PSB-QC group） or bronchoalveolar lavage（ BAL-QC group）. The sensitivity and specificity for diagnosing bronchial-pulmonary fungal infection by two sampling methods were compared. Meanwhile the pulse oxygen saturation,heart rate,blood pressure,and adverse events were recorded for safety evaluation. Results PSB-QC and BAL-QC diagnostic techniques had similar accuracy. There was no significant difference in isolating predonminant pathogens,fungi proportions,diagnostic sensitivity,or specificity between two techniques（ 2〈 3. 84,P 〉 0. 05）. The coincidence rate of these two techniques was 92. 5%. In the bronchial-pulmonary fungal infection cases,the positive diagnostic rate of BAL-QC was significantly higher than that of PSB-QC（ 22. 2% vs. 12%,2=0. 948,P 〈 0. 05）. No serious complications including death occurred during bronchoscopic sampling procedure. The total incidence rate of adverse events in the BAL-QC group was higher than that in the PSBQC group（ 2= 28. 57,P 〈 0. 05）. Conclusions Bronchoscopic PSB is a safe and simple minimally invasive sampling technique for AECOPD patients. Sampling pathogenic fungal culture can provide etiological evidence for diagnosis of bronchial-pulmonary fungal infection and colonization,and is worthy of clinical use.

关 键 词：慢性阻塞性肺疾病 急性加重 单套管保护性毛刷 支气管-肺真菌感染 

分 类 号：R563.9[医药卫生—呼吸系统]