Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate
Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate
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DOI：
10.1086/516782
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发表时间：
2007-06-01
影响因子：
11.8
通讯作者：
Pasvol, Geoffrey
中科院分区：
文献类型：
--
作者：
Brown, Michael;Varia, Hansa;Pasvol, Geoffrey
背景。许多患有肺结核的成年人无法咳痰。洗胃、使用高渗盐水雾化诱导痰以及支气管镜检查和支气管肺泡灌洗均已用于获取标本进行诊断，但据我们所知，诱导痰的时间和量尚未得到很好的研究，也没有对这3种方法进行比较。该研究连续招募了胸片检查结果提示结核病但无法咳痰的成年住院患者。受试者在第 1 天提供 3 份诱导痰样本进行培养，并在第 2 天和第 3 天提供额外样本。此外，在第 1 天、第 2 天和第 3 天收集胃洗液标本。部分涂片结果呈阴性的受试者接受了支气管肺泡灌洗。结果。该研究招募了 140 名受试者。在提供 3 份胃洗液样本和至少 3 份诱导痰样本的 107 名受试者中，43% 的结核分枝杆菌培养结果呈阳性。使用 3 次诱导痰样本比使用 3 次洗胃液检测到更多病例（39% vs. 30%；P = .03）。在获得所有 5 份诱导痰标本培养结果的 79 名受试者中，一天内进行的诱导痰和 3 天以上进行的诱导痰所获得的样本之间没有差异（34% 与 37%；）。痰量与阳性培养结果之间没有关联。没有其他病例 Pp。 21例接受支气管镜检查的患者中确诊63例。结论。对于不能自发咳痰的患者，使用 3 次诱导痰样本诊断结核病比使用 3 次洗胃液更敏感。使用支气管镜检查并进行支气管肺泡灌洗并不能提高诊断敏感性。样品可以在 1 天内收集，从而可以更快地诊断、更快地开始治疗并缩短住院时间。
Background. Many adults with pulmonary tuberculosis are unable to expectorate. Gastric washing, sputum induction using nebulized hypertonic saline, and bronchoscopy with bronchoalveolar lavage have all been used to obtain specimens for diagnosis, but to our knowledge, the timing and volume of induced sputum have not been well studied, and these 3 methods have not been compared.Methods. The study recruited consecutive adult inpatients with chest radiography findings suggestive of tuberculosis who were unable to expectorate. Subjects provided 3 induced sputum samples for culture on day 1 and additional samples on days 2 and 3. In addition, gastric washing specimens were collected on days 1, 2, and 3. A proportion of subjects with negative smear results underwent bronchoalveolar lavage.Results. The study recruited 140 subjects. Among 107 subjects who provided 3 gastric washing specimens and at least 3 induced sputum specimens, 43% had cultures positive for Mycobacterium tuberculosis. Use of 3 induced sputum samples detected more cases than did use of 3 gastric washings (39% vs. 30%; P = .03). Among 79 subjects with culture results for all 5 induced sputum specimens, there was no difference in yield between samples obtained by induced sputum induction performed in a single day or that performed over 3 days (34% vs. 37%;). There was no association between sputum volume and positive culture results. No additional cases were Pp. 63 diagnosed in the 21 patients who underwent bronchoscopy.Conclusions. Use of 3 induced sputum samples was more sensitive than use of 3 gastric washings for diagnosis of tuberculosis in patients who could not expectorate spontaneously. Use of bronchoscopy with bronchoalveolar lavage did not increase diagnostic sensitivity. Samples could be collected in 1 day, allowing for faster diagnosis, faster initiation of treatment, and shorter hospital stay.