Steiner S, Schwalen A, Klein R M, Jablonowski H, Thomas L, Perings C, Strauer B E, Leschke M
Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität Düsseldorf.
Pneumologie. 1998 Dec;52(12):694-9.
Fibreoptic bronchoscopy is an established diagnostic procedure for HIV-associated pulmonary infections. We retrospectively evaluated the diagnostic effectivity and safety of fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) in 153 patients with late-stage HIV infection and clinical signs of pulmonary infection or abnormal chest radiograph. Bronchoscopy leads to diagnosis in 82.4% and changed therapy in 54%. 45 patients (30%) were found to have pneumocystis carinii pneumonia (PCP), the most common bronchoscopic finding, followed by bacterial lung disease (29.3%). BAL had a sensitivity of 78% for PCP. Diagnostic yield of BAL for PCP was higher in patients without previous treatment (positive results in 82%) with regard to PCP independend of the prior treatment. Serious complication occurred in 22 cases (pneumothorax: 6 (3.9%), bleeding: 12 (7.8%), hypoxaemia: 4 (2.6%)). High serum levels of lactate dehydrogenase (LDH) correlated with pulmonary complications like pneumothorax. Age, sex and kind of pulmonary infection did not influence complication rates. 6 (3.9%) episodes of spontaneous pneumothorax occurred in the further course, 3 of them concurrently with PCP or prior history of PCP. We conclude that fibreoptic bronchoscopy is of great value for diagnosing pulmonary infection in HIV-seropositive patients. TBB provides incremental diagnostic information not available from BAL, especially in patients pretreated with cotrimoxazol or pentamidin. For that reason we believe that TBB should be performed in these patients.
纤维支气管镜检查是诊断HIV相关肺部感染的一种成熟的诊断方法。我们回顾性评估了153例晚期HIV感染且有肺部感染临床症状或胸部X线异常的患者，采用支气管肺泡灌洗（BAL）和经支气管活检（TBB）进行纤维支气管镜检查的诊断有效性和安全性。支气管镜检查确诊率为82.4%，改变治疗方案率为54%。45例（30%）患者被发现患有卡氏肺孢子虫肺炎（PCP），这是最常见的支气管镜检查结果，其次是细菌性肺部疾病（29.3%）。BAL对PCP的敏感性为78%。对于PCP，未接受过治疗的患者BAL的诊断阳性率更高（82%呈阳性结果），与先前治疗无关。22例出现严重并发症（气胸：6例（3.9%），出血：12例（7.8%），低氧血症：4例（2.6%））。高血清乳酸脱氢酶（LDH）水平与气胸等肺部并发症相关。年龄、性别和肺部感染类型不影响并发症发生率。在后续病程中发生6例（3.9%）自发性气胸，其中3例与PCP同时发生或有PCP既往史。我们得出结论，纤维支气管镜检查对诊断HIV血清阳性患者的肺部感染具有重要价值。TBB能提供BAL无法获得的额外诊断信息，尤其是在接受过复方新诺明或喷他脒预处理的患者中。因此，我们认为这些患者应进行TBB。
