Baughman R P, Dohn M N, Loudon R G, Frame P T
University of Cincinnati Medical Center.
Chest. 1991 Jan;99(1):92-7. doi: 10.1378/chest.99.1.92.
To determine the utility of bronchoscopy with bronchoalveolar lavage for diagnosing M tuberculosis and fungal infections.
Retrospective review of patients over a six-year period.
In- and outpatients of one University hospital and affiliated Veterans Administration Medical Center.
Those who were subsequently found to have either M tuberculosis or fungal infections.
Bronchoscopy with bronchoalveolar lavage specimens were compared to prebronchoscopy sputum, when available. Specimens were sent for smear and culture for both acid-fast bacilli and fungi. In the case of lavage, an aliquot also was studied for cellular differential.
For TB, sputum was smear-positive in 6/47 (34 percent) and culture positive in 24/47 (51 percent), while bronchoscopy was smear positive in 34/50 (68 percent) and culture positive in 46/50 (92 percent). For fungal infections, no sputum was smear-positive and only 1/22 (5 percent) was sputum culture-positive, while bronchoscopy was smear-positive in 14/41 (34 percent) and culture positive in 35/41 (85 percent). Bronchoscopy washings and BAL provided complementary specimens. Eighty-three patients had adequate lavages and the cellularity was significantly different from controls (lymphocytes: TB 18 +/- 11.2 percent [mean +/- SD]; fungal: 13 +/- 11.1 percent; controls 6 +/- 3.1 percent; p less than 0.001; neutrophils: TB 9 +/- 11.5 percent; fungal: 6 +/- 9.1 percent controls: 2 +/- 1.5 percent, p less than 0.01); however, there was overlap and no pattern was characteristic for TB or fungal infections.
Bronchoscopy with BAL is useful in diagnosing tuberculosis and fungal infections.
确定支气管镜检查及支气管肺泡灌洗术在诊断结核分枝杆菌和真菌感染中的作用。
对六年期间的患者进行回顾性研究。
一所大学医院及其附属退伍军人管理局医疗中心的门诊和住院患者。
随后被发现患有结核分枝杆菌感染或真菌感染的患者。
将支气管镜检查及支气管肺泡灌洗标本与支气管镜检查前的痰液标本（如有）进行比较。标本送去进行抗酸杆菌和真菌的涂片及培养。对于灌洗标本，还对一份等分标本进行细胞分类研究。
对于结核病，痰液涂片阳性率为6/47（34%），培养阳性率为24/47（51%），而支气管镜检查涂片阳性率为34/50（68%），培养阳性率为46/50（92%）。对于真菌感染，痰液涂片均为阴性，仅1/22（5%）痰液培养阳性，而支气管镜检查涂片阳性率为14/41（34%），培养阳性率为35/41（85%）。支气管镜冲洗液和支气管肺泡灌洗提供了互补的标本。83例患者灌洗充分，细胞数量与对照组有显著差异（淋巴细胞：结核病患者18±11.2%[平均值±标准差]；真菌感染患者13±11.1%；对照组6±3.1%；p<0.001；中性粒细胞：结核病患者9±11.5%；真菌感染患者6±9.1%；对照组2±1.5%，p<0.01）；然而，存在重叠，且没有结核病或真菌感染的特征性模式。
支气管镜检查及支气管肺泡灌洗术有助于诊断结核病和真菌感染。
