支氣管肺泡灌洗液診斷肺結(jié)核的診斷的價(jià)值應(yīng)用

1、支氣管肺泡灌洗液診斷肺結(jié)核的診斷的價(jià)值應(yīng)用Diagnostic Value of Rapid Culture for Mycobacterium Tuberculosis in BALF in Atypical Pulmonary TuberculosisFU Wen（Department of Respiration，Xishan Coal and Electricity Group workers Hospital，Taiyuan 0*，Shanxi，China）Abstract：Objective To evaluate diagnostic significance of rapid

2、culture for Mycobacterium tuberculosis in bronchoalveolar lavage fluid（BALF）for atypical pulmonary tuberculosis.Methods Bronchial brushing ，and rapid culture for Mycobacterium tuberculosis were performed for 98 cases with atpical pulmonary tuberculosis who han no sputum or negative sputum acid-fast

3、staining ，of them 30 casea underwent transbronchial lung biopsy.Results The 20cases ，66.3% were confirmde by bronchial brushing ，84.8% were confirm by rapid culture for Mycobacterium tuberculosis in BALF.Among the20casea who underwent transbronchial lung biopsy ，pulmonary tuberculosis was confirmde

4、in 66.7%. Conclusion Rapid culture for Mycobacterium tuberculosis in BALF is of significant value for the diagnosis of atypical pulmonary tuberculosis with no sputum or negative sputum acid-fast staining.Key 1/3 的人曾受到結(jié)核分枝桿菌的X線胸片檢查和臨床癥狀不典型難98 例痰菌陰性或無(wú)痰住院結(jié)核患者行經(jīng)電子支氣管鏡防污染支氣管肺泡灌洗， 防污染支氣管肺泡灌洗快速結(jié)核菌培養(yǎng)，皆在探討防污

5、染支氣管肺泡灌洗技術(shù)對(duì)痰菌陰性肺結(jié)核的診斷價(jià)值，現(xiàn)報(bào)道如下。資料與方法ft197 例患者，98 例為99 例臨床癥臨床癥狀、體征不典型、既往無(wú)病史，需進(jìn)一步明確診斷。方法CT 3510%福爾馬林液固定3720ml23次在相應(yīng)的肺段35% 以上，收集的灌洗液做結(jié)核分支桿菌快速培養(yǎng)內(nèi)送檢。試驗(yàn)過(guò)程 刷檢涂片做萋-尼抗酸染色鏡檢。將灌洗液標(biāo)本首先，培養(yǎng)管上進(jìn)行標(biāo)記，并打開(kāi)管蓋，放入0.5ml營(yíng)養(yǎng)添加劑，然后根據(jù)情況放入 0.1ml 抗菌素混合劑溶液，加入 0.5ml 標(biāo)本，蓋緊、混勻，置入溫箱培養(yǎng)。次日每天用熒光檢測(cè)分支桿菌生長(zhǎng)。陽(yáng)性標(biāo)本通過(guò)肉眼就能夠看見(jiàn)均勻渾濁、小顆粒物質(zhì)等陽(yáng)性管應(yīng)涂片并進(jìn)行快速

6、抗酸染色，結(jié)果為陽(yáng)性時(shí)即可報(bào)告分支桿菌生長(zhǎng)陽(yáng)性或抗酸染色陽(yáng)性，約 10d 左右可得到結(jié)果。支氣管鏡消毒方法 反復(fù)沖洗腔內(nèi)，腔外擦洗，流水沖洗20min，2%戊二醛浸泡 20min，紫外線照射 60min，并對(duì)鏡檢后是影響下一次受檢結(jié)果加以對(duì)比。1結(jié)果98 例經(jīng)支氣管鏡刷檢涂片查抗酸桿菌、灌洗液結(jié)核分支桿菌快速培養(yǎng)，陽(yáng)性率分別為%8%（。30例，其中18例為慢性炎癥，肺結(jié)核陽(yáng)性率為（?？焖倥囵B(yǎng)與刷檢、病理比較，有顯著性差異。其中僅刷檢涂片陽(yáng)性8例，僅灌洗液快20例，僅活檢病理示結(jié)核肉芽腫237例支氣管鏡檢術(shù)后8152例，涂片、299例中應(yīng)用支氣管鏡刷檢、活檢、119例陽(yáng)性肺結(jié)核鏡檢患者采用生理鹽水涂片及快速培養(yǎng)檢查結(jié)核分支桿菌均為陰 2d內(nèi)痰中夾雜少且無(wú)出現(xiàn)嚴(yán)重并發(fā)癥。討論本文認(rèn)為，98 例非典型肺結(jié)核刷檢涂片菌陽(yáng)性率 67.34%，活檢病理結(jié)核陽(yáng)性率 60%，灌洗液結(jié)核分支桿菌陽(yáng)性率84.69%，灌洗液結(jié)核分支桿菌跨省培養(yǎng)菌陽(yáng)性率高于刷檢菌陽(yáng)性率，高于活檢病理結(jié)核陽(yáng)性率（P0.05）4 例僅術(shù)后痰