不同痰标本留取方法对肺部真菌感染患者痰检结果的影响

摘要

目的：探讨3种不同标本留取方法对肺部真菌感染患者痰结果的影响。方法选取2008年3月~2014年1月本院收治的512例疑诊肺部真菌感染患者，对其普通咳痰、同期采用一次性无菌吸痰管及纤支镜防污毛刷采集的痰标本行真菌涂片镜检、培养，结合临床资料进行回顾性分析，比较不同方法下痰标本合格率、检出率及临床诊断意义。结果一次性无菌吸痰管吸痰、纤支镜防污毛刷取痰及普通咳痰标本合格率分别为91.02%、92.60%及35.08%，痰涂片直接镜检/培养检出率分别为61.56%/60.09%、63.24%/64.84%及45.38%/33.11%。前2种采样方法标本的检出率比较，差异无统计学意义(P>0.05)，但均显著高于普通咳痰的检出率(P<0.01)。前2种方法采集痰标本检查结果在肺部真菌感染诊断中的敏感度、特异度、阳性预测值及阴性预测值分别为66.76%、97.79%、98.82%、51.55%。结论医师全程督导下行一次性无菌吸痰管与纤支镜防污毛刷采样标本的合格率及检出率有较好的一致性，与普通咳痰比较，均有助于提高肺部真菌感染的诊断率，但一次性无菌吸痰管采样更为简便、经济，适用于基层医疗机构。%Objective To explore the influence of sputum specimens by three different collecting methods on sputum outcomes in patients with pulmonary fungal infection. Methods 512 patients with suspected diagnosis of pulmonary fungal infection admitted into our hospital from March 2008 to January 2014 were selected.Ordinary expectoration,dis-posable sterile suction tube and bronchofiberscope anti-pollution brush were used to collect sputum specimens for fun-gal smear and culture.Together with clinical data,a retrospective analysis was implemented aiming at comparing quali-fied rate and detection rate of sputum specimen and clinical diagnostic significance by different methods. Results Qual-ified rates of sputum specimens collected by disposable sterile suction tube,bronchoscopy and sputum stain brush bron-chofiberscope anti-pollution brush and ordinary expectoration respectively was 91.02%,92.60% and 35.08%.Detection rates of smear for direct microscopic examinations /culture on sputum specimens by these three methods respectively-was 61.56%/60.09%,63.24%/64.84% and 45.38%/33.11%.There was no statistical difference in detection rate of the first two sputum specimens (P>0.05),but the detection rates by the first two collecting methods were both significantly higher than that by ordinary expectoration with statistical differences (P<0.01).The sensitivity,specificity,positive predic-tive value and negative predictive value of sputum specimens outcomes collecting by the first two methods in the diag-nosis of pulmonary fungal infection was 66.76%,97.79%,98.82%,51.55%in turn. Conclusion Qualified rate and detec-tion rate of specimens by disposable sterile suction tube and bronchofiberscope anti-pollution brush are in good consis-tency under physician’s full supervision. In comparison with ordinary expectoration,they are both beneficial to improve the diagnosis of pulmonary fungal infection. However,disposable sterile suction tube is more simple and economical,and applicable for grass-root medical organizations.