支气管镜联合T-SPOT对肺结核的诊断效能评价  

Evaluation of bronchoscopy combined with T-SPOT in the diagnosis of tuberculosis

作　　者：房延凤[1] 顾兴[1] 金发光[1] 孙瑞琳[1] 傅恩清[1] 鲁曦[1] 

机构地区：[1]第四军医大学唐都医院呼吸与危重症医学科,710038

出　　处：《实用医学杂志》2017年第10期1682-1684,共3页The Journal of Practical Medicine

基　　金：国家公益性行业科研专项(编号:201402024)

摘　　要：目的:探讨支气管镜联合T-SPOT对肺结核的诊断效能。方法:纳入2015年2月至2016年4月我科住院的高度疑似肺结核病例248例,据痰标本来源途径不同分为对照组、雾化组、支气管镜组,据检查方式的不同分为支气管镜组、T-SPOT组、支气管镜+T-SPOT组,行各组痰抗酸涂片阳性率、肺结核诊断率及诊断效能的比较及支气管镜安全性的评估。结果:支气管镜组痰抗酸涂片阳性率最高(37.173%),3组间有统计学差异(P=0.001);支气管镜+T-SPOT组肺结核诊断率最高(92.670%),3组间有统计学差异(P=0.000);支气管镜+T-SPOT组诊断肺结核的特异度、灵敏度、阳性预测值、阴性预测值、阳性似然比及约登指数最高,阴性似然比最低;支气管镜组并发症有3例出血,1例气胸,1例心律失常。结论:支气管镜联合T-SPOT可提升肺结核的诊断效能,安全可靠。Objective To explore the diagnostic efficacy of bronchoscopy combined with T-SPOT in tuberculosis. Methods Totally 248 highly suspected tuberculosis patients were included from February 2015 to April 2016 in our department. According to the different sources of sputum specimens, they were divided into control group, atomization group and bronchoscope group ; Depending on the mode of examination, they were divided into bronchoscopy group, T-SPOT group, bronchoscopy＋T-SPOT group.To compare anti-acid smear positive rate, tuberculosis diagnosis and diagnostic efficacy in each group and safety of bronchoscopy. Results The rate of sputum specimens smear-positive was the highest （37.173%） in bronchoscopy.There were statistically significant of the three groups （P = 0.001 ） ; The highest diagnostic rate of pulmonary tuberculosis was （92.670%） in Bronchoscopy＋ T-SPOT group, three groups were statistically significant （P = 0.000）. The specificity, sensitivity, positive predictive value, negative predictive value, positive likelihood ratio and Jorden index were highest in diagnosing tuberculosis of bronchoscopy＋T-SPOT group, negative likelihood ratio was lowest. There were Complications of three cases of bleeding, one case of pneumothorax, one case of arrhythmia in bronchoscopy group. Conclusion Bronchoscopy combined with T-SPOT can improve the diagnostic efficacy of tuberculosis, safe and reliable.

关 键 词：肺结核 支气管镜 T-SPOT 诊断效能 

分 类 号：R521[医药卫生—内科学]