CAJ | 학술논문

目的探讨超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA)诊断细菌培养阴肺结核的有效性.方法对于3次常规结核杆菌痰检阴性、伴肺门和(或)纵隔淋巴结肿大临床疑似肺结核的患者随机分为2组,比较支气管肺泡灌洗组即BAL组(对照组)和EBUS+ BAL组(试验组)诊断菌阴肺结核的差异.结果筛选115例患者,其中82例患者进入该研究,对照组40例,试验组42例.对照组通过细菌学明确诊断8例,诊断性抗结核治疗后明确诊断27例,手术证实非结核诊断5例；试验组通过细菌学和病理学明确诊断28例,假阴性8例,其他诊断6例.EBUS+BAL组诊断敏感性为77.8％,显著高于BAL组的22.9％ (x2 =21.4,P＜0.01)；EBUS+BAL组阴性预测值也显著高于BAL组(42.9％对15.6％,x2=3.97,P=0.046).两组间并发症相似,仅1例试验组穿刺点出血需要止血干预.结论 EBUS-TBNA对菌阴肺结核伴肺门和(或)纵隔淋巴结肿大的患者诊断敏感性和阴性预测值高,并发症少,将成为菌阴肺结核患者一种新的诊断方式.
목적 탐토초성지기관경인도하적경지기관침흡활검(EBUS-TBNA)진단세균배양음폐결핵적유효성.방법 대우3차상규결핵간균담검음성、반폐문화(혹)종격림파결종대림상의사폐결핵적환자수궤분위2조,비교지기관폐포관세조즉BAL조(대조조)화EBUS+ BAL조(시험조)진단균음폐결핵적차이.결과사선115례환자,기중82례환자진입해연구,대조조40례,시험조42례.대조조통과세균학명학진단8례,진단성항결핵치료후명학진단27례,수술증실비결핵진단5례；시험조통과세균학화병이학명학진단28례,가음성8례,기타진단6례.EBUS+BAL조진단민감성위77.8％,현저고우BAL조적22.9％ (x2 =21.4,P＜0.01)；EBUS+BAL조음성예측치야현저고우BAL조(42.9％대15.6％,x2=3.97,P=0.046).량조간병발증상사,부1례시험조천자점출혈수요지혈간예.결론 EBUS-TBNA대균음폐결핵반폐문화(혹)종격림파결종대적환자진단민감성화음성예측치고,병발증소,장성위균음폐결핵환자일충신적진단방식.
Objective To evaluate the diagnostic role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the smear and culture negative tuberculosis.Methods The tuberculosis suspected patients with spu-tum-negative for three times and with hilar or mediastinal lymphadenopathy were randomly divided into 2 groups,study group received EBUS-TBNA and bronchoalveolar lavage group(BAL) examination,control group received BAL examination only.Chi-square test was used to compare their diagnostic sensitivity and negative predictive value.Results Totally 82 patients were included this study,40 patients were in control group and 42 in the study group.In the control group,tuberculosis was confumed in only 8 cases by means of bacteriological examination in the BAL fluid,27 were confirmed by the following surgery ordiagnostic treatment of anti-Tuberculosis,and the other 5 cases were diagnosis as other diseases; In the study group,tuberculosis was confirmed in 28 patients through bacteriological and pathological examination,8 were false negative and the other 6 were diagnosis as non-tuberculosis diseases.The diagnostic sensitivity in the study group was significantly higher than that in control group (77.8％ verus 22.9％,x2 =21.4,P ＜ 0.01 ) ; and the negative predictive value in the EBUS-TBNA group was also significantly higher than that in the BAL group (42.9％ VS 15.6％,x2 =3.97,P =0.046).Complications were similar inthese 2 groups,only 1 case of intervention required puncture site bleeding happened in the study group.Conclusion EBUSTBNA has a higher sensitivity and negative predictive value in the diagnosis of smear and culture negative pulmorary tuberculosis patients with hilar or mediastinal lymph nodes.This technique is a safe method with few complications than the traditional BAL examination.It may play an important role in the diagnosis of smear and culture negative tuberculosis patients.