超声引导下经支气管针吸活检术获取组织标本 培养在肺部感染性疾病诊疗中的应用观察.

Objective To investigate the application value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA） for tissue culture in the diagnosis and treatment of pulmonary infectious diseases. Methods Twenty-nine patients with suspected pulmonary infectious disease due to treatment failure were selected and received EBUS-TBNA for tissue culture, including 14 cases who underwent bronchoalveolar lavage fluid culture. We recorded the microbial culture results of tissue specimens obtained by EBUS-TBNA and bronchoalveolar lavage fluid and evaluated whether the microorganisms cultured by EBUS-TBNA tissue specimens and bronchoalveolar lavage fluid were responsible pathogens for pulmonary infection, and then we calculated the clinical consistency rate, sensitivity and specificity. Based on the microbial culture results of EBUS-TBNA tissue specimens, treatment strategies were adjusted. We recorded out‐comes and effective rate of the patients and the occurrence of complications during and after EBUS-TBNA. Results Among 29 cases, 22 were finally diagnosed with pulmonary infectious diseases, of whom 17 cases had positive results for microbial culture by EBUS-TBNA, with the positive rate of 77. 3%(17/22). Five of 14 patients who underwent microbial culture by bronchoalveolar lavage fluid had positive results, with the positive rate of 35. 7%(5/14), which was lower than that of EBUS-TBNA(P<0. 05). Among the 17 patients with positive microbial culture of EBUS-TBNA, the consistency rate of clinically responsible pathogen was 70. 6%(12/17）, and the treatment response rate was 70. 6%(12/17). The clinical agreement rate of Streptococci as the responsible pathogens in patients with microbial culture results as streptococci by EBUS-TBNA was 87. 5%(7/8）, and the treatment response rate was 100%(7/7）. The sensitivity and specificity of EBUS-TBNA tissue specimens for microbial culture for the determination of responsible pathogens were 80. 0% and 28. 6%, respectively. Due to the confounding effects of tuberculosis and viral pneumonia, the clinical consistency rate of EBUS-TBNA tissue specimens in comparison with the final diagnosis of disease was 63. 6%(14 / 22）, which was higher than that of bronchoalveolar lavage fluid culture(P<0. 05）. The clinical consistency rate of 14 patients who underwent bronchoalveolar lavage fluid culture was 20. 0%(1/5）. All patients had no major hemoptysis during surgery and no emerging bloodstream infections after surgery. One case of pneumothorax occurred after surgery, and the chest tightness was improved after thoracic puncture and aspiration. After surgery, five cases showed mild blood in sputum, which stopped spontaneously after it is not treated. Conclusions EBUS-TBNA for microbial culture is easier to detect pathogens and has a higher clinical agreement rate than bronchoalveolar lavage fluid, which is helpful to improve the detection rate of clinically responsible pathogens, especially Streptococci. It is helpful to improve the detection rate of clinically responsible pathogens, especially Streptococcus, and guide clinical treatment with high safety. [ABSTRACT FROM AUTHOR]