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目的探讨经纤维支气管镜(简称纤支镜)单套管保护性毛刷采样病原菌培养对于支气管-肺真菌感染所致慢性阻塞性肺疾病(简称慢阻肺)急性加重的诊断价值及安全性。方法选择2011年1月至2012年12月上海仁济医院和长征医院呼吸科收治住院的符合入选标准的73例慢阻肺急性加重患者进行回顾性分析,所有患者均进行经纤支镜单套管保护性毛刷病原菌采样培养(PSB-QC)和肺泡灌洗液真菌培养(BAL-QC),比较两种方法诊断支气管-肺真菌感染的敏感性和特异性。同时分析入选患者纤支镜检查中指脉氧饱和度、心率和血压变化及不良事件发生率以评估其安全性。结果 PSB-QC和BAL-QC诊断技术具有相似的准确度,两组在分离优势病原菌、真菌构成比、诊断敏感性、特异性方面比较均无明显差异(2<3.84,P>0.05)。两者完全一致性为92.5%。在各诊断分组中,确诊组诊断阳性率为22.2%和12%(2=0.948,P>0.05)。所有病例在纤支镜检查操作过程中均未发生严重并发症和死亡。总不良反应发生率BAL-QC组高于PSB-QC组,两组比较差异有统计学意义(2=28.57,P<0.05)。结论在慢阻肺急性加重患者中应用经纤支镜单套管保护性毛刷采样方法是一种安全、简便、易被患者接受的微创技术,采样病原菌真菌培养能为支气管-肺真菌感染与定植提供一定病原学诊断依据,具有一定的临床应用价值。
Objective To investigate the diagnostic value and safety of bronchoscopy (single bronchoscope) single-tube protective brush-sampled pathogen culture for acute exacerbation of chronic obstructive pulmonary disease (COPD) caused by bronchopulmonary infection. Methods Seventy-three patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Department of Respiratory Medicine, Shanghai Renji Hospital and Changzheng Hospital from January 2011 to December 2012 were retrospectively analyzed. All patients underwent single-fiber PSB-QC and BAL-QC were used to detect the sensitivity and specificity of bronchopulmonary infection. At the same time, we analyzed the changes of pulse oxygen saturation, heart rate and blood pressure and the incidence of adverse events in the selected patients to evaluate their safety. Results The diagnostic accuracy of PSB-QC and BAL-QC was similar. There was no significant difference (P <0.05) between the two groups in the pathogenicity of the isolated pathogens, fungal composition ratio, diagnostic sensitivity and specificity. The exact consistency between the two is 92.5%. In each diagnosis group, the positive rate of diagnosis in the diagnosis group was 22.2% and 12% (2 = 0.948, P> 0.05). In all cases, no serious complications and death occurred during the operation of bronchoscopy. The incidence of total adverse reactions in BAL-QC group was higher than that in PSB-QC group, the difference was statistically significant (2 = 28.57, P <0.05). Conclusions The method of using brush-assisted single-cannula protection brush in patients with acute exacerbation of chronic obstructive pulmonary disease is a safe, simple and easy-to-use minimally invasive technique. The fungal culture of the pathogenic fungi can be a bronchopulmonary fungal infection And provide some etiological diagnosis of colonization, with a certain clinical value.