Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis - Experience at an acquired immune deficiency syndrome reference center in Rio de Janeiro, Brazil
Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis - Experience at an acquired immune deficiency syndrome reference center in Rio de Janeiro, Brazil
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DOI：
10.1164/ajrccm.162.6.2003125
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发表时间：
2000-12-01
影响因子：
24.7
通讯作者：
Kritski, AL
中科院分区：
文献类型：
--
作者：
Conde, MB;Soares, SLM;Kritski, AL
许多疑似肺结核（PTB）的患者不会自发产生痰液或抗酸杆菌（AFB）涂片阴性。我们前瞻性地比较了痰诱导（SI）和纤维支气管镜检查与支气管肺泡灌洗（BAL）在结核病和人类免疫缺陷病毒（HIV）感染高发地区诊断PTB的产率。57%（143/251）的患者被诊断为肺结核，其中17%（25/143）的患者为艾滋病毒血清阳性。无论是通过SI还是BAL获得的AFB涂片或培养物的产率均无显著差异。在207例HIV血清阴性患者中，通过SI和BAL获得的标本的AFB涂片和分枝杆菌培养结果的一致性分别为97%（202/207）（kappa检验= 0.92）和90%（186/207）（kappa检验= 0.78）。在HIV血清阳性患者中，SI和BAL标本的AFB涂片和培养结果之间的一致性分别为98%（43/44）（kappa检验= 0.93）和86%（38/44）（kappa检验= 0.69）。我们的结论是，SI是一个安全的程序，诊断率高，与纤维支气管镜检查结果的HIV血清阴性和HIV血清阳性患者的PTB的诊断高度一致。
Many patients with suspected pulmonary tuberculosis (PTB) do not produce sputum spontaneously or are smear-negative for acid-fast bacilli (AFB). We prospectively compared the yield of sputum induction (SI) and fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) for the diagnosis of PTB in a region with a high prevalence of tuberculosis and human immunodeficiency virus (HIV) infection. Fifty seven percent (143 of 251) of patients had diagnoses of PTB, of whom 17% (25 of 143) were HIV seropositive. There were no significant differences in the yields of AFB smears or cultures whether obtained via SI or BAL Among 207 HIV-seronegative patients, the AFB smear and mycobacterial culture results from specimens obtained by SI and BAL were in agreement in 97% (202 of 207) (kappa test = 0.92) and 90% (186 of 207) (kappa test = 0.78), respectively. Among HIV-seropositive patients the agreements between AFB smear and culture results for SI and BAL specimens were 98% (43 of 44) (kappa test = 0.93) and 86% (38 of 44) (kappa test = 0.69), respectively. We conclude that SI is a safe procedure with a high diagnostic yield and high agreement with the results of fiberoptic bronchoscopy for the diagnosis of PTB in both HIV-seronegative and HIV-seropositive patients.