可弯曲支气管镜检查在免疫功能低下且伴有肺部浸润患者中的作用。

Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates.

作者信息

Jain Prasoon, Sandur Sunder, Meli Yvonne, Arroliga Alejandro C, Stoller James K, Mehta Atul C

机构信息

Department of Medicine, Louis A. Johnson Veterans Affairs Medical Center, Clarksburg, WV, USA.

出版信息

Chest. 2004 Feb;125(2):712-22. doi: 10.1378/chest.125.2.712.

DOI:10.1378/chest.125.2.712

PMID:14769756

Abstract

STUDY OBJECTIVE

To study the diagnostic role of flexible bronchoscopy (FB) in immunocompromised patients with pulmonary infiltrates.

DESIGN

Prospective, observational study.

SETTING

Tertiary care hospital.

PATIENTS

A total of 104 consecutive non-HIV-infected immunocompromised patients with lung infiltrates in whom FB was performed.

METHODS

The primary outcome measure was the diagnostic yield of FB, which was derived as the number of the diagnoses made using FB results divided by all final diagnoses. Final diagnoses were established using data from FB, surgical lung biopsy (SLB), and microbiology and serology testing, and by the clinical response to empiric therapy. We also studied the diagnostic yields of individual sampling procedures such as BAL, transbronchial biopsy (TBB), and protected-specimen brush (PSB) sampling.

RESULTS

Overall, 128 diagnoses were made in 104 patients. The overall diagnostic yield of FB was 56.2% (95% confidence interval [CI], 47 to 64%). FB provided at least one diagnosis in 53 of 104 patients (51%; 95% CI, 40 to 62%). FB was more likely to establish the diagnosis when the lung infiltrate was due to an infectious agent (81%; 95% CI, 67 to 90%) than to a noninfectious process (56%; 95% CI, 43 to 67%; p = 0.011). The diagnostic yields of BAL (38%; 95% CI, 30 to 47%) and TBB (38%; 95% CI, 27 to 51%) were similar (p = 0.94). The diagnostic yield of PSB sampling was lower (13%; 95% CI 6 to 24%; p = 0.001) than that of BAL. The combined diagnostic yield of BAL and TBB (70%; 95% CI, 57 to 80%) was higher than that of BAL alone (p < 0.001). Finally, the diagnostic yield of FB with PSB sampling, BAL, and TBB was similar to that of FB with BAL and TBB. The complication rate from FB was 21% (95% CI, 15 to 31%). Minor bleeding (13%) and pneumothorax (4%) were the most common complications.

CONCLUSIONS

FB has a high diagnostic yield in immunocompromised patients with pulmonary infiltrates. Based on our results, we recommend performing TBB in these patients, whenever possible.

摘要

研究目的

探讨可弯曲支气管镜检查（FB）在免疫功能低下且有肺部浸润患者中的诊断作用。

设计

前瞻性观察性研究。

地点

三级医疗中心。

患者

共104例连续的非HIV感染的免疫功能低下且有肺部浸润并接受FB检查的患者。

方法

主要观察指标为FB的诊断率，通过使用FB检查结果做出的诊断数量除以所有最终诊断数量得出。最终诊断依据FB、外科肺活检（SLB）、微生物学和血清学检测数据以及对经验性治疗的临床反应来确定。我们还研究了单个采样程序（如支气管肺泡灌洗（BAL）、经支气管活检（TBB）和防污染样本毛刷（PSB）采样）的诊断率。

结果

总体而言，104例患者共做出128项诊断。FB的总体诊断率为56.2%（95%置信区间[CI]，47%至64%）。FB在104例患者中的53例（51%；95%CI，40%至62%）中至少做出了一项诊断。当肺部浸润由感染因素引起时，FB更有可能确诊（诊断率81%；95%CI，67%至90%），而由非感染性病变引起时诊断率为56%（95%CI，43%至67%；p = 0.011）。BAL（诊断率38%；95%CI，30%至47%）和TBB（诊断率38%；95%CI，27%至51%）的诊断率相似（p = 0.94）。PSB采样的诊断率较低（13%；95%CI，6%至24%；p = 0.001），低于BAL。BAL和TBB联合的诊断率（70%；95%CI，57%至80%）高于单独BAL的诊断率（p < 0.001）。最后，FB联合PSB采样、BAL和TBB的诊断率与FB联合BAL和TBB的诊断率相似。FB的并发症发生率为21%（95%CI，15%至31%）。轻微出血（13%）和气胸（4%）是最常见的并发症。