Title: Prospective Study of Sputum Induction, Gastric Washing, and Bronchoalveolar Lavage for the Diagnosis of Pulmonary Tuberculosis in Patients Who Are Unable to Expectorate
Author: Michael Brown,1,a Hansa Varia,1 Paul Bassett,1 Robert N. Davidson,1 Robert Wall,2 and Geoffrey Pasvol1
Sourse: Clinical Infectious Diseases 2007;44:1415-1420
Background. Many adults with pulmonary tuberculosis are unable to expectorate. Gastric washing, sputum induction using nebulized hypertonic saline, and bronchoscopy with bronchoalveolar lavage have all been used to obtain specimens for diagnosis, but to our knowledge, the timing and volume of induced sputum have not been well studied, and these 3 methods have not been compared.
Methods. The study recruited consecutive adult inpatients with chest radiography findings suggestive of tuberculosis who were unable to expectorate. Subjects provided 3 induced sputum samples for culture on day 1 and additional samples on days 2 and 3. In addition, gastric washing specimens were collected on days 1, 2, and 3. A proportion of subjects with negative smear results underwent bronchoalveolar lavage.
Results. The study recruited 140 subjects. Among 107 subjects who provided 3 gastric washing specimens and at least 3 induced sputum specimens, 43% had cultures positive for Mycobacterium tuberculosis. Use of 3 induced sputum samples detected more cases than did use of 3 gastric washings (39% vs. 30%; P = .03). Among 79 subjects with culture results for all 5 induced sputum specimens, there was no difference in yield between samples obtained by induced sputum induction performed in a single day or that performed over 3 days (34% vs. 37%; P = .63). There was no association between sputum volume and positive culture results. No additional cases were diagnosed in the 21 patients who underwent bronchoscopy.
Conclusions. Use of 3 induced sputum samples was more sensitive than use of 3 gastric washings for diagnosis of tuberculosis in patients who could not expectorate spontaneously. Use of bronchoscopy with bronchoalveolar lavage did not increase diagnostic sensitivity. Samples could be collected in 1 day, allowing for faster diagnosis, faster initiation of treatment, and shorter hospital stay.
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初译：
Title: Prospective Study of Sputum Induction, Gastric Washing, and Bronchoalveolar Lavage for the Diagnosis of Pulmonary Tuberculosis in Patients Who Are Unable to Expectorate
诱导咳痰、洗胃及支气管肺泡灌洗对不能咳痰病人肺结核诊断的前瞻性研究
Author: Michael Brown,1,a Hansa Varia,1 Paul Bassett,1 Robert N. Davidson,1 Robert Wall,2 and Geoffrey Pasvol1
Sourse: Clinical Infectious Diseases 2007;44:1415-1420
Background. Many adults with pulmonary tuberculosis are unable to expectorate. Gastric washing, sputum induction using nebulized hypertonic saline, and bronchoscopy with bronchoalveolar lavage have all been used to obtain specimens for diagnosis, but to our knowledge, the timing and volume of induced sputum have not been well studied, and these 3 methods have not been compared.
背景：许多具有肺结核的成人不能咳痰。洗胃，使用高张生理盐水雾化诱导咳痰，以及用支气管肺泡灌洗进行的支气管镜检查均被运用于诊断获得的样本，但据我们所认识到，诱导咳痰的时机和容量还未被研究，并且这3种方法尚未比较。
Methods. The study recruited consecutive adult inpatients with chest radiography findings suggestive of tuberculosis who were unable to expectorate. Subjects provided 3 induced sputum samples for culture on day 1 and additional samples on days 2 and 3. In addition, gastric washing specimens were collected on days 1, 2, and 3. A proportion of subjects with negative smear results underwent bronchoalveolar lavage.
方法：本研究纳入通过胸部X 线片检查后的系列住院成人，研究发现表明结核患者不能咳痰。受试者提供了第1天的3个诱导咳痰标本作培养以及在第2 及3天再补充标本。此外，在第1, 2和3天收集患者的洗胃样本。一部分受试者的阴性涂片结果行支气管肺泡灌洗。
Results. The study recruited 140 subjects. Among 107 subjects who provided 3 gastric washing specimens and at least 3 induced sputum specimens, 43% had cultures positive for Mycobacterium tuberculosis. Use of 3 induced sputum samples detected more cases than did use of 3 gastric washings (39% vs. 30%; P = .03). Among 79 subjects with culture results for all 5 induced sputum specimens, there was no difference in yield between samples obtained by induced sputum induction performed in a single day or that performed over 3 days (34% vs. 37%; P = .63). There was no association between sputum volume and positive culture results. No additional cases were diagnosed in the 21 patients who underwent bronchoscopy.
结果：这项研究纳入了140例受试者。在107例受试者中，有3 次洗胃样本以及至少3次诱导咳痰样本，43％受试者的结核分枝杆菌培养阳性。3 次诱导咳痰样本的检测可检测出更多比通过用3次洗胃样本检测出的分枝杆菌（39%对比30%；P = .03)。在79例受试者的所有5次诱导咳痰培养中，通过3日诱导咳痰或1日诱导咳痰之间获得的样本无明显差异（34％对比37％；P = .63)。在痰液量以及阳性培养结果之间并无相关性。在21例行支气管镜检查患者中并未诊断出其他疾病。
Conclusions. Use of 3 induced sputum samples was more sensitive than use of 3 gastric washings for diagnosis of tuberculosis in patients who could not expectorate spontaneously. Use of bronchoscopy with bronchoalveolar lavage did not increase diagnostic sensitivity. Samples could be collected in 1 day, allowing for faster diagnosis, faster initiation of treatment, and shorter hospital stay.
结论：运用3次诱导咳痰比3次洗胃诊断不能自行咳痰的结核病人更具敏感性。支气管肺泡灌洗的支气管镜检查不能增加诊断敏感性。行1天内收集样本可快速诊断，快速治疗且可以缩短住院日。
编译投稿：（592字）
【据《临床感染疾病》杂志2007年44卷发表的研究报道】题为：诱导咳痰、洗胃及支气管肺泡灌洗对不能咳痰病人肺结核诊断的前瞻性研究
此前瞻性研究的背景为许多具有肺结核的成人不能咳痰。洗胃，使用高张生理盐水雾化诱导咳痰，以及用支气管肺泡灌洗进行的支气管镜检查均被运用于诊断获得的样本，诱导咳痰的时机和容量还未被研究，并且这3种方法尚未比较。研究中纳入通过胸部X 线片检查后的住院成人140例，研究发现表明结核患者不能咳痰。受试者提供了第1天的3个诱导咳痰标本作培养以及在第2 及3天再补充标本。此外，在第1, 2和3天收集患者的洗胃样本。一部分受试者的阴性涂片结果行支气管肺泡灌洗。结果显示，在107例受试者中，有3 次洗胃样本以及至少3次诱导咳痰样本，43％受试者的结核分枝杆菌培养阳性。3 次诱导咳痰样本的检测可检测出更多比通过用3次洗胃样本检测出的分枝杆菌（39%对比30%；P = .03)。在79例受试者的所有5次诱导咳痰培养中，通过3日诱导咳痰或1日诱导咳痰之间获得的样本无明显差异（34％对比37％；P = .63)。在痰液量以及阳性培养结果之间并无相关性。在21例行支气管镜检查患者中并未诊断出其他疾病。由此研究人员提出结论，运用3次诱导咳痰比3次洗胃诊断不能自行咳痰的结核病人更具敏感性。支气管肺泡灌洗的支气管镜检查不能增加诊断敏感性。行1天内收集样本可快速诊断，快速治疗且可以缩短住院日。
