Bandyopadhyay T, Gerardi D A, Metersky M L
Pulmonary Division, University of Connecticut School of Medicine, Farmington, Conn., USA.
Respiration. 2000;67(2):173-6. doi: 10.1159/000029482.
Sputum induction has proved useful in the diagnosis of Pneumocystis carinii pneumonia and mycobacterial infections but there are scant data on its use in the diagnosis of community-acquired pneumonia (CAP).
To better define the usage of sputum induction by hypertonic saline in the setting of CAP.
A retrospective review of records of patients admitted to a community teaching hospital in the year 1995 with a diagnosis of CAP.
Of 492 patients admitted with CAP, 71 (14%) had attempted sputum induction. A group of 66 patients with CAP and attempted sputum collection by spontaneous expectoration was compared with this group. Sputum induction failed to yield a sample in 22 patients (31%). Forty-five of 49 patients (92%) with induced sputum had received prior antibiotics as compared to 23 of 34 patients (68%) with expectorated samples (p < 0.05), due to sputum induction often being attempted later in the hospital course. The diagnostic yield of sputum induction was 14 of 71 (20%) compared to 16 out of 66 (24%) for attempted spontaneously expectorated samples. Antibiotic therapy was changed for 5 of 34 patients (15%) who spontaneously expectorated samples and for 9 of 49 patients (18%) with successful induction.
Sputum induction is effective in obtaining sputum in some patients with CAP who fail to expectorate a sample. Attempting induction early, preferably before starting antibiotics, may increase its diagnostic yield.
痰液诱导已被证明在卡氏肺孢子虫肺炎和分枝杆菌感染的诊断中有用，但关于其在社区获得性肺炎（CAP）诊断中的应用数据很少。
更好地明确高渗盐水诱导痰液在CAP中的应用情况。
回顾性分析1995年一所社区教学医院收治的诊断为CAP的患者记录。
492例因CAP入院的患者中，71例（14%）尝试进行痰液诱导。将一组66例尝试通过自然咳痰采集痰液的CAP患者与该组进行比较。22例患者（31%）痰液诱导未能获得样本。49例诱导痰液患者中有45例（92%）此前接受过抗生素治疗，而34例咳痰样本患者中有23例（68%）接受过抗生素治疗（p<0.05），这是因为痰液诱导通常在住院病程后期进行。痰液诱导的诊断阳性率为71例中的14例（20%），而尝试自然咳痰样本的阳性率为66例中的16例（24%）。34例自然咳痰样本患者中有5例（15%）和49例诱导成功患者中有9例（18%）的抗生素治疗方案发生了改变。
痰液诱导对一些无法咳出样本的CAP患者获取痰液有效。尽早尝试诱导，最好在开始使用抗生素之前，可能会提高其诊断阳性率。
