30例不典型肺结核临床特点及诊断方法分析  

Analysis of clinical characteristics and diagnostic methods of 30 cases of atypical pulmonary tuberculosis

作　　者：戴梦缘 尤青海[1] DAI Mengyuan;YOU Qinghai(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230032,China)

机构地区：[1]安徽医科大学第一附属医院呼吸与危重症医学科,安徽合肥230032

出　　处：《临床肺科杂志》2023年第8期1190-1194,共5页Journal of Clinical Pulmonary Medicine

基　　金：安徽省高校科学研究项目(No.KJ2020A0175)。

摘　　要：目的 探讨不典型肺结核临床特点及诊断方法。方法 收集安徽医科大学第一附属医院呼吸与危重症医学科2019年11月至2022年11月确诊的30例不典型肺结核患者,分析相关临床资料、痰液及支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)检验结果、结核相关检验指标、胸部影像学等检查资料。结果 共纳入30例BALF mNGS检出结核分枝杆菌的不典型肺结核患者,其中男性20例(66.7%),女10例(33.3%),年龄在15岁至78岁,临床表现为4例有发热,18例有咳嗽咳痰,3例有咯血,8例有胸闷,3例有胸痛。影像学主要表现为肺叶/段实变,肺部孤立/多发结节/肿块,间质性改变,肺内空洞影及肺不张。30例患者均接受气管镜检查,支气管肺泡灌洗术联合mNGS技术均检出结核分枝杆菌序列。BALF涂片阳性率为23.3%,传统痰涂片检测方法阳性率为13.3%,气管镜活检病理阳性率为16.7%,QFT-IT及T-SPOT阳性率分别为85.7%及88.9%。BALF mNGS检测阳性率为100%,与传统痰涂片法、BALF涂片法、气管镜活检病理、T-SPOT及QFT-IT比较均具有统计学意义(P<0.001)。结论 不典型肺结核诊断难度大,气管镜检查联合病原菌mNGS有助于临床早期精准诊断和治疗不典型肺结核,改善患者预后。Objective To explore the clinical characteristics and diagnostic methods of atypical pulmonary tuberculosis.Methods It collected 30 patients diagnosed with atypical pulmonary tuberculosis in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Anhui Medical University from November 2019 to November 2022.Relevant clinical data,sputum and bronchoalveolar lavage fluid(BALF)test results,tuberculo-related test indicators,chest imaging data and other examination data were analyzed.Results A total of 30 patients with atypical pulmonary tuberculosis detected by BALF mNGS were included,including 20 males and 10 females,aged from 15 to 78 years old.The clinical manifestations were fever in 4 cases,cough and phlegm in 18 cases,hemoptysis in 3 cases,chest tightness in 8 cases and chest pain in 3 cases.The main imaging findings were lung lobe/segment consolidation,isolated/multiple nodules/masses,interstitial changes,pulmonary cavity shadow and atelectasis.The positive rate of BALF smear and traditional sputum smear were 23.3%and 13.3%respectively.The positive rate of tracheoscopy biopsy pathology was 16.7%.The positive rates of QFT-IT and T-SPOT were 85.7%and 88.9%respectively.The positive rate of BALF mNGS test was 100%,which was statistically significant compared with traditional sputum smear,BALF smear,tracheoscopy biopsy pathology,T-SPOT and QFT-IT(P<0.001).Conclusion The combination of bronchoscopy and BALF mNGS is helpful for accurate diagnosis and treatment of atypical pulmonary tuberculosis in early clinical stage and can improve the prognosis of patients.

关 键 词：支气管肺泡灌洗液 宏基因组下一代测序技术 病原体检测 不典型肺结核 

分 类 号：R521[医药卫生—内科学]