O. Freund, Yitzhac Hadad, Tomer Lagziel, I. Friedman Regev, E. Kleinhendler, A. Unterman, A. Bar-Shai, T. Perluk
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引用次数: 0
摘要
高度怀疑肺结核(HS-PTB)的住院病人在确诊前应隔离治疗。如果痰标本阴性后仍有疑问,通常会进行支气管镜检查和支气管肺泡灌洗(BAL)。然而,BAL 在这类患者中的附加值证据仍然很少。为了解决这一问题,我们纳入了在 2017 年至 2018 年期间接受 BAL 检查的连续 HS-PTB 患者,这些患者的痰标本均为阴性。胸部 X 光片 (CXR) 和 CT 扫描由对最终诊断保密的胸部放射科医生进行评估。以 2017 年至 2019 年间所有 PTB 阳性患者(通过痰或 BAL)为对照组(n = 41),通过多变量回归评估 PTB 的独立预测因素。共纳入 42 名 HS-PTB 患者(平均年龄为 51 ± 9 岁,36% 为女性)。BAL可诊断为PTB的病例有3例(7%),诊断为其他临床相关病原体的病例有6例(14%)。PTB 的独立预测因素包括:≥2 个亚急性症状(调整 OR 3.18,95% CI 1.04-9.8)、CXR 上叶合并症(AOR 8.70,95% CI 2.5-29)和胸部 CT 中的中心叶结节(AOR 3.96,95% CI 1.20-13.0,P = 0.02)。总之,在痰标本阴性后,对 HS-PTB 住院患者进行支气管镜和 BAL 检查可增加 7% 的诊断价值。我们的研究结果强调了 PTB 诊断的特定预测因素,这些因素可用于未来的对照研究,以实现诊断评估的个性化。
The Added Value of Bronchoalveolar Lavage for Pulmonary Tuberculosis Diagnosis in High-Risk Hospitalized Patients with Negative Sputum Samples
Hospitalized patients with a high suspicion of pulmonary tuberculosis (HS-PTB) are isolated until a definite diagnosis can be determined. If doubt remains after negative sputum samples, bronchoscopy with bronchoalveolar lavage (BAL) is often sought. Still, evidence of the added value of BAL in this patient population is scarce. To address this issue, we included consecutive HS-PTB patients with negative sputum samples who underwent BAL between 2017 and 2018. Chest X-rays (CXR) and CT scans were evaluated by a chest radiologist blind to the final diagnosis. Independent predictors for PTB were assessed by multivariate regression, using all positive PTB patients between 2017 and 2019 (by sputum or BAL) as a control group (n = 41). Overall, 42 HS-PTB patients were included (mean age 51 ± 9, 36% female). BAL was a viable diagnostic for PTB in three (7%) cases and for other clinically relevant pathogens in six (14%). Independent predictors for PTB were ≥2 sub-acute symptoms (adjusted OR 3.18, 95% CI 1.04–9.8), CXR upper-lobe consolidation (AOR 8.70, 95% CI 2.5–29), and centrilobular nodules in chest CT (AOR 3.96, 95% CI 1.20–13.0, p = 0.02). In conclusion, bronchoscopy with BAL in hospitalized patients with HS-PTB had a 7% added diagnostic value after negative sputum samples. Our findings highlight specific predictors for PTB diagnosis that could be used in future controlled studies to personalize the diagnostic evaluation.
期刊介绍:
"Advances in Respiratory Medicine" is a new international title for "Pneumonologia i Alergologia Polska", edited bimonthly and addressed to respiratory professionals. The Journal contains peer-reviewed original research papers, short communications, case-reports, recommendations of the Polish Respiratory Society concerning the diagnosis and treatment of lung diseases, editorials, postgraduate education articles, letters and book reviews in the field of pneumonology, allergology, oncology, immunology and infectious diseases. "Advances in Respiratory Medicine" is an open access, official journal of Polish Society of Lung Diseases, Polish Society of Allergology and National Research Institute of Tuberculosis and Lung Diseases.