抗酸菌症
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概要

Using Bronchoalveolar Lavage Fluid for Active Pulmonary Tuberculosis Laboratory Diagnosis

Song Yang*, Jian-Qiong Guo, You-Ming Fan, Mei Han, Xiao-Feng Yan, Wu-Yang Yue, Qian Qiu, Le-LeWang,QiangZhongSun, Ling Jiang, Tong-Xin Li

Objective: To evaluate the diagnostic efficiency of Bronchoalveolar Lavage Fluid (BALF) for Mycobacterium tuberculosis (MTB) infection using laboratory methods.

Methods: A retrospective study was conducted in patients diagnosed with Active Pulmonary Tuberculosis (APTB) and lacking sputum quality/quantity. Bronchoalveolar Lavage Fluid (BALF) collected during the operation processes of electric bronchoscopy were tested using Ziehl-Neelsen Staining Acid-Fast Bacilli Smear Microscopy (Z-N-AFB-SM), GeneXpert MTB/RIF (Xpert), Loop-Mediated Isothermal Amplification (LAMP), or culturing with BACTEC^™ Mycobacterial Growth Indicator Tube™ 960 (MGIT). Chi-square test was used for statistical analysis.

Results: 331 suspected APTB patients were enrolled in this study. 224 of whom were sputum-scarce. 89 were sputum-sufficient and tested negative in both Z-N-AFB-SM and MGIT 960. Among the sputum sufficient patients, BALF-testing confirmed APTB diagnosis in 20.2% (18/89) via Z-N-AFB-SM, and 53.0% (35/89) via MGIT. The total positive rates of BALF testing via four aforementioned methods were 18.2% (57/313), 66.4% (168/253), 61.0% (83/136) and 48.2% respectively. The positive rate of MTB discovered in BALF collected by well-trained respiratory physicians are significantly higher than those collected by anesthetists (χ²=22.48, P<0.01). Total adverse events incidence of BAL was 1.9% (6/313).

Conclusion: BALF has a similar sensitivity and specificity for APTB laboratory diagnosis. It can be used as a complementary diagnostic method for APTB when sputum availability is poor. The proficiency of BALF collection is an important factor affecting the detection results.