上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (12): 1621-1626.doi: 10.3969/j.issn.1674-8115.2020.12.009

• 论著·临床研究 • 上一篇    下一篇

肺部感染患者痰液与肺泡灌洗液病原菌分布及培养结果分析

秦 蓉1, 2，何 平1，张颐豪2，王砚春3   

  1. 1. 上海交通大学基础医学院免疫学与微生物系，上海 200025；2. 上海交通大学医学院附属仁济医院南院检验科，上海 201114；3. 复旦大学附属肿瘤医院检验科，上海 200032
  • 出版日期:2020-12-28 发布日期:2021-02-02
  • 通讯作者: 王砚春，电子信箱：springor1988@alumni.sjtu.edu.cn。
  • 作者简介:秦 蓉（1991—），女，检验技师，学士；电子信箱：echoqr@sina.com。
  • 基金资助:
    国家自然科学基金（81971896）。

Analysis of distribution and culture results of pathogens in sputum and bronchoalveolar lavage fluid from patients with pulmonary infection

QIN Rong1, 2, HE Ping1, ZHANG Yi-hao2, WANG Yan-chun3   

  1. 1. Department of Immunology and Microbiology, Shanghai Jiao Tong University College of Basic Medical Sciences, Shanghai 200025, China; 2. Department of Laboratory Medicine, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai 201114, China; 3. Department of Laboratory Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China
  • Online:2020-12-28 Published:2021-02-02
  • Supported by:
    National Natural Science Foundation of China (81971896).

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摘要： 目的·分析肺部感染患者的痰液（sputum，SP）与肺泡灌洗液（bronchoalveolar lavage fluid，BALF）中的病原菌（真菌及细菌）分布，并探索该2种下呼吸道样本在临床感染诊断中的价值。方法·回顾性研究上海交通大学医学院附属仁济医院南院临床微生物室于2018年1月—2019年6月间收集的肺部感染患者SP与BALF样本的培养结果，其中2种样本采集时间间隔小于24 h。采用统计描述与一致性检验比较分析2种样本的病原菌分布情况。结果·在313例肺部感染患者中，BALF样本的细菌培养阳性率为27.55%（73/265），真菌培养阳性率为16.61%（49/295）；SP样本的细菌培养阳性率为25.38%（67/264），真菌培养阳性率则较高[26.13%（75/287）]。从阳性培养的病原菌种类看，BALF与SP样本的培养结果基本一致。综合所有患者的病原菌培养结果发现，2种样本的定性结果总一致率为75.08%（235/313）；其中，真菌的一致率为79.09%（227/287）且具有显著一致性（P=0.000，Kappa=0.390），细菌的一致率为90.91%（240/264）且亦具有显著一致性（P=0.000，Kappa=0.767）。结论·在一定条件下，临床可优先考虑SP培养以避免BALF有创检查。当SP培养结果与临床不符，尤其是高度怀疑侵袭性肺部真菌感染时，应及时采取BALF检查以明确病原菌感染。

关键词: 肺泡灌洗液, 痰液, 细菌培养, 真菌培养

Abstract:

Objective · To analyze the distribution of pathogens (fungi and bacteria) in sputum (SP) and bronchoalveolar lavage fluid (BALF) from patients with pulmonary infection, and explore the value of the two kinds of lower respiratory tract specimens in the diagnosis of clinical infection. Methods · The culture results of SP and BALF specimens from patients with pulmonary infection in the Department of Clinical Microbiology of Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine from January 2018 to June 2019 were retrospectively studied. The time interval between the two specimens was less than 24 h. Statistical description and consistency test were used to compare and analyze the distribution of pathogens between the two specimens. Results · Among the 313 patients with pulmonary infection, the positive rate of bacterial culture in BALF specimens was 27.55% (73/265) and that of fungal culture was 16.61% (49/295); the positive rate of bacterial culture in SP specimens was 25.38% (67/264), and that of fungal culture was higher [26.13% (75/287)]. From the positive culture of pathogens, the culture results of BALF and SP specimens were basically consistent. Based on the pathogens culture results of the 313 patients, the overall consistency rate of the qualitative results of BALF and SP specimens was 75.08% (235/313). Among them, the consistent rate of fungal detection was 79.09% (227/287) with significant consistency (P=0.000, Kappa=0.390), and the consistent rate of bacterial detection was 90.91% (240/264) with significant consistency (P=0.000, Kappa=0.767). Conclusion · Under certain conditions, SP culture should be given priority in clinical practice to avoid invasive examination of BALF. However, when SP culture results are not consistent with clinical judgment, especially in suspicious invasive pulmonary fungal infection, the BALF should be checked in time to identify the pathogenic infection.

Key words: bronchoalveolar lavage fluid (BALF), sputum (SP), bacterial culture, fungal culture

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