Chan C H, Chan R C, Arnold M, Cheung H, Cheung S W, Cheng A F
Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT.
Q J Med. 1992 Jan;82(297):15-23.
A prospective study of the efficacy of bronchoscopy and tuberculostearic acid assay in the diagnosis of sputum smear-negative pulmonary tuberculosis (TB) was carried out in 39 patients with symptoms and radiographic changes suggestive of active pulmonary TB. The diagnosis of TB was confirmed in 15 patients, probable TB was diagnosed in eight and 16 patients did not have TB. An early diagnosis of TB was made by bronchoscopy in six patients (40 per cent). Culture of sputum obtained before bronchoscopy was positive in nine patients (60 per cent) while combined with bronchoscopy specimens, a positive mycobacterial culture was obtained in 12 patients (80 per cent). Mycobacteria were cultured from transbronchial biopsy specimens from five patients (33 per cent) but none of these was exclusively positive. Histological examination of transbronchial biopsy tissue was diagnostic of TB in four patients and it was the exclusive means of early diagnosis in two. Transbronchial biopsy also provided an alternative diagnosis in four other patients. Tuberculostearic acid assay had a sensitivity of 0.40 in bronchial aspirate, 0.80 in bronchoalveolar lavage fluid, and 0.27 in transbronchial biopsy specimens: the combined result was 0.87. In nine patients with pulmonary TB in whom an early diagnosis could not be made, the tuberculostearic acid assay was positive in seven (78 per cent). We conclude that bronchoscopy with bronchoalveolar lavage and transbronchial biopsy is helpful in providing early diagnosis and positive culture results. Assay of tuberculostearic acid in bronchoalveolar lavage fluid is a useful adjunct to early diagnosis. However, mycobacterial culture and assay of tuberculostearic acid in transbronchial biopsy specimens have little diagnostic value.
对39例有症状且影像学改变提示活动性肺结核的患者进行了一项前瞻性研究，以探讨支气管镜检查和结核硬脂酸检测在痰涂片阴性肺结核诊断中的疗效。确诊肺结核的有15例患者，疑似肺结核的有8例，16例患者未患肺结核。6例患者（40%）通过支气管镜检查得以早期诊断肺结核。支气管镜检查前获取的痰液培养，9例患者（60%）呈阳性；结合支气管镜检查标本，12例患者（80%）获得阳性分枝杆菌培养结果。5例患者（3３%）经支气管活检标本培养出分枝杆菌，但均非单纯阳性。经支气管活检组织的组织学检查确诊4例肺结核，其中2例是早期诊断的唯一手段。经支气管活检还为另外4例患者提供了其他诊断。结核硬脂酸检测在支气管吸出物中的敏感性为0.40，在支气管肺泡灌洗液中为0.80，在经支气管活检标本中为0.27，综合结果为0.87。在9例未能早期诊断的肺结核患者中，7例（78%）结核硬脂酸检测呈阳性。我们得出结论，支气管镜检查联合支气管肺泡灌洗和经支气管活检有助于早期诊断并获得阳性培养结果。支气管肺泡灌洗液中结核硬脂酸检测是早期诊断的有用辅助手段。然而，经支气管活检标本中的分枝杆菌培养和结核硬脂酸检测诊断价值不大。
