Ömer ARAZ, Metin AKGÜN, Arzu MİRİCİ, Leyla SAĞLAM, Kemalettin ÖZDEN

The diagnostic value of bronchoscopy in smear negative cases with pulmonary tuberculosis

Pulmoner tüberküloz şüphesi olduğu halde balgam yayması negatif olan olgularda bronkoskopinin yararlı olduğunu gösteren çok sayıda çalışma bulunmaktadır. Ancak hangi olgularda bronkoskopinin daha yararlı olduğu konusunda yeterli veri bulunmamaktadır. Bu çalışmada hangi olgularda bronkoskopinin daha fazla tanı koydurucu olduğu, hangi olgularda endobronşiyal tutulumun daha fazla bulunabileceği araştırıldı. Bu amaçla tüberküloz şüphesi olan, balgam incelemesinin negatif olduğu 60 olguya bronkoskopi yapıldı. Tüberküloz tanısı konulan olgulardan bronkoskopi ile tanı konulan ve konulamayan olgular ile endobronşiyal tüberküloz belirlenen ve belirlenemeyen olguların özellikleri karşılaştırıldı. Bronkoskopi ile sonradan tüberküloz tanısı doğrulanan 38 olgunun 29 (%76)’una tanı konuldu. Olguların 7 (%18)’sinde de endobronşiyal tutulum tespit edildi. Bronkoskopi ile tanı konulan olguların ortalama serum C-reaktif protein (CRP) düzeyleri tanı konulamayan olgulara göre anlamlı derecede yüksekti (p< 0.05). Endobronşiyal tutulum olan olgular diğer olgularla karşılaştırıldığında da bu olgularda semptom süresinin daha kısa (p= 0.01), tüberkülin deri testi (TDT)’nde endürasyon çapının daha küçük (p< 0.05) ve ortalama serum CRP düzeyinin daha yüksek (p< 0.05) olduğu görüldü. Çalışmanın sonuçları yüksek serum CRP düzeyi olan olgularda bronkoskopi ile tanı konulma olasılığının daha fazla olduğunu; TDT yanıtının oluşmadığı, semptom süresinin kısa olduğu ve CRP düzeyinin yüksek olduğu hastalığın erken ve aktif döneminde endobronşiyal tutulumun tespit edilme olasılığının daha fazla olduğunu düşündürmektedir. Ancak bu hipotezin desteklenmesi için yeni ve daha büyük çalışmalar gereklidir.

Yayma negatif pulmoner tüberkülozlu olgularda bronkoskopinin tanısal değeri

There are many studies showing usefulness of bronchoscopy in patients with suspected pulmonary tuberculosis (Tbc) and negative sputum smear. However, there is no enough data concerning that in which cases bronchoscopy is more useful. We aimed to investigate in which cases bronchoscopy is more diagnostic and also an in which cases presence of endobronchial involvement is more likely. A total of 60 smear negative patients undergoing bronchoscopy due to tuberculosis suspicion were evaluated. The characteristics of cases with or without positive diagnosis via bronchoscopy and also of the ones with or without endobronchial involvement were compared. Bronchoscopy provided positive result for Tbc in 29 (76%) of 38 cases with confirmed as Tbc later and 7 (18%) cases had endobronchial involvement. In the cases who are diagnosed as Tbc via bronchoscopy, the mean serum levels of C-reactive protein (CRP) were significantly higher than those of undiagnosed (p< 0.05). In the cases with endobronchial involvement, the duration of symptoms was significantly shorter (p= 0.01); the diameter of tuberculin skin test induration was significantly smaller (p< 0.05); and mean serum level of CRP was significantly higher (p< 0.05) than those of without endobronchial lesion. The results suggest that it is more likely to diagnose Tbc bronchoscopically in the cases who had increased serum levels of CRP, and possibility of endobronchial involvement may be increased among the cases in active and earlier period of the disease. However, further studies are required to support this hypothesis

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