Scott J P, Fradet G, Smyth R L, Mullins P, Pratt A, Clelland C A, Higenbottam T, Wallwork J
Transplant Unit, Papworth Hospital, Cambridge, England.
J Heart Lung Transplant. 1991 Sep-Oct;10(5 Pt 1):626-36; discussion 636-7.
A prospective study of 219 bronchoscopies in 54 heart-lung and in 2 single lung transplant recipients was undertaken over a 12-month period by a single operator. For histologic study, an average of 17.3 transbronchial biopsy specimens (range, 6 to 56) were taken from three lobes (or from two lobes and lingula of one lung). A further two specimens were taken for culture. The average procedure time was 14.4 minutes (SE 0.31). An estimate of the probability of rejection being missed, depending on the number of specimens taken and based on the method of Gilman and Wang, suggests 18 biopsy specimens are required to have 95% confidence of diagnosing rejection. Sensitivity for diagnosing rejection by histologic study of transbronchial biopsy specimens was 94%, and specificity was 90%. The simple grading of severity of rejection that was used was related both to the number of specimens demonstrating rejection and to the severity of graft airway mucosal inflammation seen at bronchoscopy. The major complication encountered, on 27 occasions, was bleeding of more than 100 ml. On no occasion did bleeding result in any long-term complication. Extensive transbronchial biopsy is a simple, relatively safe, and quick procedure, with a high sensitivity and specificity for diagnosing rejection and lung infection.
一名操作者在12个月内对54例心肺移植受者和2例单肺移植受者的219次支气管镜检查进行了前瞻性研究。为进行组织学研究，平均从三个肺叶（或一个肺的两个肺叶及舌叶）获取17.3份经支气管活检标本（范围为6至56份）。另外获取两份标本用于培养。平均操作时间为14.4分钟（标准误0.31）。根据所取标本数量并基于吉尔曼和王的方法对漏诊排斥反应概率的估计表明，需要18份活检标本才能有95%的把握诊断排斥反应。经支气管活检标本组织学研究诊断排斥反应的敏感性为94%，特异性为90%。所采用的排斥反应严重程度简单分级与显示排斥反应的标本数量以及支气管镜检查时所见移植气道黏膜炎症的严重程度均相关。共出现27次主要并发症，即出血超过100毫升。出血从未导致任何长期并发症。广泛经支气管活检是一种简单、相对安全且快速的操作，对诊断排斥反应和肺部感染具有较高的敏感性和特异性。
