McCubbin M M, Trigg M E, Hendricker C M, Wagener J S
Pediatric Pulmonology Division, University of Missouri-Kansas City, Children's Mercy Hospital 64108.
Pediatr Pulmonol. 1992 Jan;12(1):43-7. doi: 10.1002/ppul.1950120110.
Pulmonary complications are a frequent cause of morbidity and mortality following bone marrow transplantation. We examined the results of flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) in 27 pediatric bone marrow transplant (BMT) recipients with 29 episodes of pulmonary complications. Bone marrow transplant was performed for a variety of malignancies and hematologic disorders. Median age of BMT was 10.3 years (range, 1.7-17.6 years). Median time of FB following BMT was 60 days (range, 11-1,026 days). Routine cytologic and culture techniques were utilized to detect malignant cells, viruses, fungi, bacteria, and protozoa. Positive results were found in 15 (52%) with cytomegalovirus (CMV), the most common positive finding. In 14 (48%) episodes the results were negative. Fourteen patients had follow-up autopsy or open lung biopsy (OLB). Based on autopsy/OLB results, there were two false negatives and no false positives, giving a diagnostic sensitivity of 75% and specificity of 100%. There was one possible complication of FB and BAL. Survival of both positive and negative patients was poor, only seven patients being alive 90 days post-FB with BAL. We conclude that FB with BAL is a safe and accurate procedure for the diagnosis of pulmonary complications of BMT.
肺部并发症是骨髓移植后发病和死亡的常见原因。我们检查了27例儿科骨髓移植（BMT）受者发生29次肺部并发症时的纤维支气管镜检查（FB）和支气管肺泡灌洗（BAL）结果。进行骨髓移植的原因包括各种恶性肿瘤和血液系统疾病。BMT受者的中位年龄为10.3岁（范围为1.7 - 17.6岁）。BMT后进行FB的中位时间为60天（范围为11 - 1026天）。采用常规细胞学和培养技术检测恶性细胞、病毒、真菌、细菌和原生动物。15例（52%）检测到巨细胞病毒（CMV）呈阳性，这是最常见的阳性结果。14例（48%）检测结果为阴性。14例患者进行了后续尸检或开胸肺活检（OLB）。根据尸检/OLB结果，有2例假阴性，无假阳性，诊断敏感性为75%，特异性为100%。FB和BAL有1例可能的并发症。阳性和阴性患者的生存率都很低，只有7例患者在FB联合BAL后90天仍存活。我们得出结论，FB联合BAL是诊断BMT肺部并发症的一种安全且准确的方法。
