支气管肺泡灌洗液结核杆菌检测在菌阴肺结核中的诊断价值

余欢成　陈玲　祝国强

[摘要] 目的 探討支气管肺泡灌洗液（BALF）结核杆菌检测在菌阴肺结核诊断中的应用价值。 方法 选取2016年4月～2017年6月我院住院及门诊共60例痰结核菌阴性的肺部感染者行支气管检查，收集BALF进行涂片找抗酸杆菌、结核杆菌培养、荧光定量PCR检测结核DNA，以分析我院BALF检测在菌阴性肺结核患者中的诊断价值。结果 BALF三种检查方法确诊肺结核患者26例，占43.3%。荧光定量PCR在菌阴性肺结核患者中的检测灵敏度为84.5%，特异度为94.1%，阳性预测值为91.7%，阴性预测值为88.9%；培养法在菌阴性肺结核灵敏度为46.2%，特异度为100.0%，阳性预测值为100.0%，阴性预测值70.8%，与非结核疾病比较，检测结果均具有统计学差异（P<0.05）。 结论 支气管肺泡灌洗术是一项安全的检测技术，BALF结核杆菌检测可提高菌阴肺结核的诊断阳性率，荧光定量PCR检测具有快速、特异性高的特点，具有较高的诊断价值。

[关键词] 肺泡灌洗液；菌阴肺结核；荧光定量PCR；诊断

[中图分类号] R521 [文献标识码] B [文章编号] 1673-9701（2018）12-0073-03

Diagnostic value of the detection of mycobacterium tuberculosis in bronchioloalveolar lavage fluid in bacteria negative pulmonary tuberculosis

YU Huancheng CHEN Ling ZHU Guoqiang LIU Yun

Department of Respiratory Medicine，the Fifth Affiliated Hospital of Nanchang University，the First Peoples Hospital of Fuzhou in Jiangxi Province，Fuzhou 344000， China

[Abstract] Objective To investigate the diagnostic value of the detection of mycobacterium tuberculosis in bronchoalveolar lavage fluid（BALF） in bacteria negative pulmonary tuberculosis. Methods From April 2016 to June 2017， 60 patients with pulmonary infection who were negative to sputum mycobacterium tuberculosis in the outpatient and inpatient departments in our hospital were examined with bronchoscopy. BALF was collected for smear test to find acid-fast bacilli， and mycobacterium tuberculosis culture， and fluorogenic quantitative PCR were carried out for the detection of tuberculosis DNA， so as to analyze the diagnostic value of BALF test in the patients with bacteria negative pulmonary tuberculosis in our hospital. Results 26 patients with pulmonary tuberculosis who were confirmed by the three methods of BALF examinations accounted for 43.3%. The detection sensitivity of fluorescent quantitative PCR in the patients with bacteria negative pulmonary tuberculosis was 84.5%， the specificity was 94.1%， the positive predictive value was 91.7%， and the negative predictive value was 88.9%； the sensitivity of culture method in the bacteria negative pulmonary tuberculosis was 46.2%， the specificity was 100.0%， the positive predictive value was 100%.0， and the negative predictive value was 70.8%. Compared with non-tuberculosis disease， the differences of test results were statistically significant. Conclusion BALF is a safe detection technique. BALF mycobacterium tuberculosis test can improve the diagnostic positive rate of bacteria negative tuberculosis. Fluorescent quantitative PCR has the characteristics of fast detection and high specificity， which has a higher diagnostic value.

[Key words] Bronchoalveolar lavage fluid（BALF）；Bacteria negative pulmonary tuberculosis；Fluorogenic quantitative PCR；Diagnosis

肺結核病是我国重点防控的慢性传染病之一，其中痰结核菌阴性肺结核占比较大，在我国约占70%[1]，且菌阴肺结核患者比例也呈上升的趋势。因肺结核患者多为少痰或无痰，以致临床上痰找抗酸杆菌、痰培养阳性率低，灵敏度差，容易漏诊、误诊。本研究对60例菌阴肺部感染患者进行支气管镜检查，留取BALF涂片找抗酸杆菌、培养结核杆菌、PCR法检测结核DNA，分析其对菌阴肺结核的诊断价值，现报道如下。

1 资料与方法

1.1 一般资料

研究对象为2016年4月～2017年6月我院门诊及住院的60例肺部感染患者。患者均经胸部影像学检查证实肺部感染，经抗生素治疗无明显改善，痰结核菌涂片3次均阴性，均未能明确诊断但临床倾向于肺结核者。……