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目的探讨拟似肺结核初次发病(初发)和初发肺结核患者,不同性质的痰标本的结核分枝杆菌涂片阳性分布(涂阳)对结果的影响,提高诊断的准确性。方法 1262例拟似肺结核初发患者,其中927例最终排除了肺结核。335例确诊为初发肺结核的患者。比较了3751份痰液标本的性状、结核分枝杆菌数量分级,确诊患者的涂片和培养阳性率。结果初发结核患者中,涂片阳性占75.2%,培养阳性占83.9%。分别为涂片培养双阳性60.30%,单涂片阳性15.52%,单培养阳性24.18%,培养的阳性率明显高于涂片(P<0.05)。不同痰标本的涂片阳性率分别是:血样痰42.70%;干乳样痰40.10%;较黏液痰32.60%;气管镜痰液27.50%;水样痰17.40%差异有统计学意义(P<0.01)。结核分枝杆菌阳性数量分级分布为:干乳样痰、血样菌痰、黏液样痰4级多见;水样痰、气管镜1级多见。结论初发病人痰培养与痰涂片二者都应重视,可增加涂片次数。不同性状的痰分级可以观察到排菌量的不同,重视干乳样、黏液样痰检查,水样痰检查不能忽视,不能过分依赖血样痰作诊断。
Objective To investigate the effect of smear positive smear of Mycobacterium smegmatis on the sputum samples of patients with primary pulmonary tuberculosis (initial onset) and primary pulmonary tuberculosis (TBI), and to improve the diagnostic accuracy. Methods A total of 1262 patients with suspected pulmonary tuberculosis were initially treated, of whom 927 patients eventually excluded tuberculosis. 335 cases of patients diagnosed with initial pulmonary tuberculosis. The characteristics of 3751 sputum samples, the number of Mycobacterium tuberculosis, the smear and the positive rate of culture were compared. Results Initial tuberculosis patients, smear positive accounted for 75.2%, positive culture accounted for 83.9%. The results showed that the positive rates of double positive 60.3%, single positive 15.52% and single positive 24.18% were significantly higher than that of smear (P <0.05). The positive rates of smear in different sputum samples were as follows: sputum 42.75%; milk dry sputum 40.10%; viscous sputum 32.60%; bronchoscopy sputum 27.50%; water sputum 17.40%, the difference was statistically significant (P <0.01 ). Mycobacterium tuberculosis positive number grading distribution: dry milk-like sputum, blood-like bacteria sputum, mucus-like sputum 4 more common; water sputum, bronchoscopy more common. Conclusions Initial sputum culture and sputum smear should pay attention to both, can increase the number of smears. Different traits of sputum grading can be observed in different amounts of bacteria discharge, emphasis on dry milk-like, mucus-like sputum examination, water-like sputum examination can not be ignored, can not be overly dependent on blood sputum for diagnosis.