支气管镜在肺结核空洞继发曲菌球的诊断价值  

Diagnostic Value of Bronchoscopy in Pulmonary Tuberculosis Cavity Secondary Aspergilloma

作　　者：肖海浩[1] 汤春梅[1] 苏铎华[1] 张琳[1] 李天义[1] 张言斌[1] XIAO Hai-hao;TANG Chun-mei;SU Duo-hua;ZHANG Lin;LI Tian-yi;ZHANG Yan-bin(Guangzhou Chest Hospital(the third district of internal medicine),Guangzhou,Guangdong,510095)

机构地区：[1]广东省广州市胸科医院内科,510095

出　　处：《岭南急诊医学杂志》2020年第3期255-257,共3页Lingnan Journal of Emergency Medicine

基　　金：广东省科技厅科技计划项目(2016ZC0217);广东省转化医学创新平台培育建设项目B类(粤卫函[2018]1254号)。

摘　　要：目的:探讨支气管镜在肺结核空洞继发曲菌球的诊断价值。方法:回顾性分析广州市胸科医院内科三区2019年1月到2020年5月期间,行支气管镜检查的97例肺结核空洞继发曲菌球患者的临床资料,通过镜下表现、病理活检、BALF-GM及BALF真菌培养了解对肺结核空洞继发曲菌球的诊断阳性率。结果:97例患者,82例在气管镜直视下予组织活检,病理活检确诊曲霉菌感染68例,阳性率82.93%(68/82);97例行支气管肺泡灌洗检查,BALF-GM阳性率92.78%(90/97),BALF培养曲霉菌阳性率59.79%(58/97)。结论:肺结核空洞继发曲菌球,临床表现和影像学缺乏特异性,支气管镜检查可以直视病变,提供重要的诊断线索,联合镜下活检、BALF-GM试验、BALF真菌培养等检查,可明显提高诊断的阳性率,对确诊起到决定性的作用。Objective:To explore the value of bronchoscopy in the diagnosis of secondary aspergilloma in pulmonary tuberculosis. Methods:From January 2019 to may 2020,the clinical data of 97 patients with secondary aspergilloma in pulmonary tuberculosis cavity who were examined by bronchoscopy were analyzed retrospectively. The positive rate of diagnosis of secondary aspergilloma in pulmonary tuberculosis cavity was determined by microscopic manifestations,pathological biopsy,BALF-GM and BALF fungal culture. Results:82 patients were given tissue biopsy under the direct vision of tracheoscope,68 patients were confirmed to be infected with Aspergillus by pathological biopsy. The positive rate was 82.93%(68/82). 97 patients were examined by bronchoalveolar lavage. The positive rate of BALF-GM was 92.78%(90/97). The positive rate of culture of Aspergillus by BALF was 59.79%(58/97).Conclusion: pulmonary tuberculosis cavity secondary aspergilloma, clinical manifestations and imaging lack of specificity,bronchoscopy can directly look at the lesion,provide important diagnostic clues,combined with under-mirror biopsy,BALF-GM test,BALF fungal culture,etc.,can significantly improve the positive rate of diagnosis and play a decisive role in the diagnosis.

关 键 词：支气管镜 肺结核 曲菌球 诊断 

分 类 号：R521[医药卫生—内科学]