超声引导下经支气管针吸活检术获取组织标本培养在肺部感染性疾病诊疗中的应用观察  

Application of EBUS-TBNA for tissue culture in diagnosis and treatment of pulmonary infectious diseases

作　　者：沙敏 刘超[1] 汪泱[1] 毛静宇[1] 苏美琴 陈成[1] SHA Min;LIU Chao;WANG Yang;MAO Jingyu;SU Meiqin;CHEN Cheng(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院呼吸与危重症医学科,江苏苏州215000

出　　处：《山东医药》2023年第23期24-28,共5页Shandong Medical Journal

基　　金：江苏省“六大人才高峰”高层次人才选拔培养资助项目(WSN-101)。

摘　　要：目的探讨超声引导下经支气管针吸活检术(EBUS-TBNA)获取组织标本培养在肺部感染性疾病诊疗中的应用价值。方法选择因经治失败、疑似肺部感染性疾病住院并接受EBUS-TBNA且完成组织标本培养的患者29例,其中行支气管肺泡灌洗液微生物培养14例。记录患者EBUS-TBNA获取组织标本及支气管肺泡灌洗液的微生物培养结果,判断EBUS-TBNA获取组织标本及支气管肺泡灌洗液培养的微生物是否为肺部感染责任病原体,计算诊断的临床符合率和敏感度、特异度;基于EBUS-TBNA获取组织标本的微生物培养结果调整抗菌治疗策略,记录患者的转归情况并计算有效率;记录患者EBUS-TBNA穿刺中及穿刺后并发症发生情况。结果29例患者中经综合诊断为肺部感染性疾病22例,其中17例EBUS-TBNA获取组织标本微生物培养阳性,阳性率为77.3%(17/22);14例行支气管肺泡灌洗液微生物培养的患者中5例微生物培养阳性,阳性率为35.7%(5/14),低于EBUS-TBNA获取组织标本(P<0.05)。17例EBUS-TBNA获取组织标本微生物培养阳性患者中,经临床判定为责任病原体的符合率为70.6%(12/17),治疗有效率为70.6%(12/17)。EBUS-TBNA获取组织标本培养出链球菌的患者责任病原体临床符合率为87.5%(7/8),治疗有效率为100%(7/7)。EBUS-TBNA获取组织标本微生物培养对责任病原体判定的敏感度和特异度分别为80.0%、28.6%;受肺结核和病毒性肺炎的混杂影响,EBUS-TBNA获取组织标本微生物培养结果与疾病最终诊断的临床符合率为63.6%(14/22)。14例行支气管肺泡灌洗液培养的患者判定为责任病原体的临床符合率为20.0%(1/5),低于EBUS-TBNA获取组织标本培养(P<0.05)。所有患者术中无大咯血,术后无新发血流感染;术后发生气胸1例,予胸腔穿刺抽气后胸闷好转;术后出现轻微痰中带血5例,未予处理后自行停止。结论EBUS-TBNA获取组织标本微生物培养较支气管肺泡灌洗液更易检�Objective To investigate the application value of endobronchial ultrasound-guided transbronchial nee⁃dle aspiration(EBUS-TBNA)for tissue culture in the diagnosis and treatment of pulmonary infectious diseases.Methods Twenty-nine patients with suspected pulmonary infectious disease due to treatment failure were selected and received EBUS-TBNA for tissue culture,including 14 cases who underwent bronchoalveolar lavage fluid culture.We recorded the microbial culture results of tissue specimens obtained by EBUS-TBNA and bronchoalveolar lavage fluid and evaluated whether the microorganisms cultured by EBUS-TBNA tissue specimens and bronchoalveolar lavage fluid were responsible pathogens for pulmonary infection,and then we calculated the clinical consistency rate,sensitivity and specificity.Based on the microbial culture results of EBUS-TBNA tissue specimens,treatment strategies were adjusted.We recorded out⁃comes and effective rate of the patients and the occurrence of complications during and after EBUS-TBNA.Results Among 29 cases,22 were finally diagnosed with pulmonary infectious diseases,of whom 17 cases had positive results for microbial culture by EBUS-TBNA,with the positive rate of 77.3%(17/22).Five of 14 patients who underwent microbial culture by bronchoalveolar lavage fluid had positive results,with the positive rate of 35.7%(5/14),which was lower than that of EBUS-TBNA(P<0.05).Among the 17 patients with positive microbial culture of EBUS-TBNA,the consistency rate of clinically responsible pathogen was 70.6%(12/17),and the treatment response rate was 70.6%(12/17).The clinical agreement rate of Streptococci as the responsible pathogens in patients with microbial culture results as streptococci by EBUS-TBNA was 87.5%(7/8),and the treatment response rate was 100%(7/7).The sensitivity and specificity of EBUS-TBNA tissue specimens for microbial culture for the determination of responsible pathogens were 80.0%and 28.6%,respectively.Due to the confounding effects of tuberculosis and viral pneumonia,the clinical

关 键 词：超声引导下经支气管针吸活检术 支气管肺泡灌洗液 链球菌 肺部感染性疾病 

分 类 号：R563[医药卫生—呼吸系统]