Ng V L, Gartner I, Weymouth L A, Goodman C D, Hopewell P C, Hadley W K
Department of Laboratory Medicine, General Hospital Medical Center, San Francisco, CA.
Arch Pathol Lab Med. 1989 May;113(5):488-93.
We describe a system for diagnosis of pulmonary disease in the human immunodeficiency virus-infected patient using induced sputum and other diagnostic procedures. This system has been successfully used at San Francisco (Calif) General Hospital for more than 2 years. It utilizes outpatient facilities and reduces the need for bronchoscopy. Sputum induced by inhalation of 3% saline mist, mucolysed, concentrated by centrifugation, and stained by a rapid modified Giemsa stain was the first diagnostic specimen examined in 404 episodes of suspected human immunodeficiency virus-associated pulmonary disease in 358 patients. Pneumocystis carinii was found in 222 (55%) sputum specimens. In 118 episodes in which the sputum did not contain P carinii, bronchoscopy with transbronchial biopsy and/or bronchoalveolar lavage was performed and P carinii was found in 50 (42%). These 118 bronchoscopy results, as well as evaluation of the subsequent clinical course of those patients who accounted for 64 episodes of lung disease and who did not have bronchoscopy following examination of nondiagnostic induced sputum, indicated a range of sensitivity for detection of P carinii in induced sputum of 74% to 77% and a negative predictive value of 58% to 64%. Mycobacteria were recovered from 11 (6%) of the induced sputum and 6 (12%) of the bronchoscopic specimens containing P carinii. However, only oral or environmental fungi were recovered from P carinii-containing induced sputum or bronchoscopic specimens. For those patients in whom P carinii was not detected, only the bronchoscopic specimens were cultured for Mycobacteria and fungi. Potentially pathogenic Mycobacteria and fungi were recovered from 16 (23.5%) and 34 (50%), respectively, of these P carinii-negative specimens. Analysis of these results, obtained under routine practice conditions, indicates that bronchoscopy should be reserved for those patients whose induced sputum examinations do not show P carinii and that mycobacterial and fungal cultures be performed only on bronchoscopic specimens in which P carinii is not detected.
我们描述了一种利用诱导痰及其他诊断程序对人类免疫缺陷病毒感染患者的肺部疾病进行诊断的系统。该系统已在加利福尼亚州旧金山总医院成功使用了两年多。它利用门诊设施，减少了支气管镜检查的需求。通过吸入3%盐水雾诱导痰液，进行黏液溶解、离心浓缩，并采用快速改良吉姆萨染色法染色，这是对358例疑似人类免疫缺陷病毒相关肺部疾病患者的404次发作进行检查时首先检测的诊断标本。在222份（55%）痰标本中发现了卡氏肺孢子虫。在118次发作中，痰中未发现卡氏肺孢子虫，于是进行了经支气管活检和/或支气管肺泡灌洗的支气管镜检查，其中50次（42%）发现了卡氏肺孢子虫。这118例支气管镜检查结果，以及对那些占64例肺部疾病且在诱导痰检查无诊断结果后未进行支气管镜检查的患者随后临床病程的评估表明，诱导痰中检测卡氏肺孢子虫的敏感性范围为74%至77%，阴性预测值为58%至64%。在11份（6%）诱导痰和6份（12%）含有卡氏肺孢子虫的支气管镜标本中发现了分枝杆菌。然而，在含有卡氏肺孢子虫的诱导痰或支气管镜标本中仅发现了口腔或环境真菌。对于那些未检测到卡氏肺孢子虫的患者，仅对支气管镜标本进行分枝杆菌和真菌培养。在这些卡氏肺孢子虫阴性标本中，分别有16份（23.5%）和34份（50%）培养出了潜在致病性分枝杆菌和真菌。在常规实践条件下获得的这些结果分析表明，支气管镜检查应仅用于那些诱导痰检查未显示卡氏肺孢子虫的患者，并且分枝杆菌和真菌培养应仅在未检测到卡氏肺孢子虫的支气管镜标本上进行。
