Funahashi A, Lohaus G H, Politis J, Hranicka L J
Thorax. 1983 Apr;38(4):267-70. doi: 10.1136/thx.38.4.267.
From January 1976 to December 1981 mycobacteria were recovered for the first time from the respiratory tract of 179 patients. Twenty-three patients had undergone fibreoptic bronchoscopy during initial investigation after three or more expectorated sputum specimens were negative for acid-fast bacilli. Three of these patients had nodular lesions on the chest radiograph and the diagnosis of mycobacterial disease was made only after thoracotomy. In the remaining 20 patients bronchial brushings yielded a positive culture in 19, while bronchial brushing was negative in one patient in whom culture of sputum before bronchoscopy had been positive. In eight of these 19 patients (group A) bronchial brushing was the only source that gave a positive result from culture, while in 11 patients (group B) both bronchial brushing and prebronchoscopy sputum yielded positive cultures. When these two groups were compared no difference was seen in their clinical presentation or radiographic findings but there was a notable difference in the quality of the presentation or radiographic findings but there was a notable difference in the quality of the prebronchoscopy sputum. Six of eight patients in group A had poor prebronchoscopy sputum, while 10 of 11 in group B had good prebronchoscopy sputum. It is concluded that, if a patient is unable to produce sputum or is able to produce only a poor specimen, fibreoptic bronchoscopy may be a useful means of obtaining additional material for culture.
1976年1月至1981年12月，首次从179例患者的呼吸道中分离出分枝杆菌。23例患者在最初检查时，经三次或更多次咳出的痰标本抗酸杆菌检查均为阴性后，接受了纤维支气管镜检查。其中3例患者胸部X线片有结节性病变，仅在开胸手术后才确诊为分枝杆菌病。在其余20例患者中，19例支气管刷检培养呈阳性，而1例患者支气管刷检阴性，该患者在支气管镜检查前痰培养为阳性。在这19例患者中的8例（A组），支气管刷检是培养结果呈阳性的唯一来源，而在11例患者（B组）中，支气管刷检和支气管镜检查前的痰培养均呈阳性。比较这两组时，在临床表现或影像学表现上未见差异，但在支气管镜检查前痰的质量上有显著差异。A组8例患者中有6例支气管镜检查前痰质量差，而B组11例中有10例支气管镜检查前痰质量好。得出的结论是，如果患者无法咳痰或只能咳出质量差的标本，纤维支气管镜检查可能是获取额外培养材料的有用方法。
