Sakashita Kentaro, Fujita Akira, Takamori Mikio, Nagai Takayuki, Matsumoto Tomoshige, Saito Takefumi, Nakagawa Taku, Ogawa Kenji, Shigeto Eriko, Nakatsumi Yasuto, Goto Hajime, Mitarai Satoshi
Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Centre, 2-8-29 Musashidai, Fuchu, Tokyo, Japan.
Department of Basic Mycobacteriology, Graduate School of Biomedical Science, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi, Nagasaki, Japan.
Clin Respir J. 2018 Apr;12(4):1503-1509. doi: 10.1111/crj.12697. Epub 2017 Sep 13.
High quality sputum helps increase the sensitivity of the diagnosis of pulmonary tuberculosis.
To evaluate the efficiency of the acoustic device (Lung Flute; LF) in sputum induction compared with the conventional method, hypertonic saline inhalation (HSI).
In this crossover study, patients with presumed pulmonary tuberculosis submitted 3 consecutive sputa: the first sputum without induction and the second and third ones using LF and HSI. We compared the efficiency of the 2 induction methods.
Sixty-four participants were eligible. Thirty-five (54.6%) patients had negative smears on the first sputum without induction. Among those patients, 25.7% and 22.9% patients were smear-positive after using LF and HSI, respectively (P = .001). The positive conversion rate was not significantly different between the methods. The first samples without induction yielded 65.7% positive cultures, whereas 71.4% and 77.1% of the samples from LF and HSI were positive, respectively (P = .284). Similar results were observed in the nucleic acid amplification test [no induction (60.0%), LF (72.0%) and HSI (60.0%); P = .341]. In 29 smear-positive patients on the first sputum without induction, we observed no significant increase in smear grade, culture yield and nucleic acid amplification test positivity with either method. LF tended to induce fewer adverse events; desaturation (3.1% vs 11.1%; P = .082) and throat pain (1.5% vs 9.5%; P = .057). LF showed significantly fewer total adverse events (15.8% vs 34.9%; P = .023).
Our study showed LF had similar sputum induction efficiency to HSI with relatively fewer complications.
高质量痰液有助于提高肺结核诊断的敏感性。
评估声学装置（肺笛；LF）与传统方法高渗盐水吸入（HSI）相比在诱导痰液方面的效果。
在这项交叉研究中，疑似肺结核患者连续提交3份痰液样本：第一份未诱导的痰液样本，以及使用LF和HSI诱导后的第二份和第三份痰液样本。我们比较了这两种诱导方法的效果。
64名参与者符合条件。35名（54.6%）患者在未诱导的第一份痰液样本涂片检查中结果为阴性。在这些患者中，使用LF和HSI诱导后涂片阳性的患者分别为25.7%和22.9%（P = 0.001）。两种方法之间的阳性转化率无显著差异。未诱导的第一份样本培养阳性率为65.7%，而来自LF和HSI的样本培养阳性率分别为71.4%和77.1%（P = 0.284）。在核酸扩增试验中观察到类似结果[未诱导（60.0%）、LF（72.0%）和HSI（60.0%）；P = 0.341]。在29名未诱导的第一份痰液样本涂片阳性的患者中，我们观察到两种方法在涂片分级、培养产量和核酸扩增试验阳性率方面均无显著提高。LF诱导的不良事件较少；血氧饱和度下降（3.1%对11.1%；P = 0.08）和咽痛（1.5%对9.5%；P = 0.057）。LF的总不良事件显著较少（15.8%对34.9%；P = 0.023）。
我们的研究表明，LF与HSI在诱导痰液方面效果相似，但并发症相对较少。
