Mason G R, Hashimoto C H, Dickman P S, Foutty L F, Cobb C J
Department of Medicine, Harbor-UCLA Medical Center, Torrance 90509.
Am Rev Respir Dis. 1989 Jun;139(6):1336-42. doi: 10.1164/ajrccm/139.6.1336.
The clinical records and bronchoalveolar lavage (BAL) cell differential counts were analyzed in 96 patients at risk for Pneumocystis carinii pneumonia (PCP) from human immunodeficiency virus (HIV) infection to determine if this information may be prognostically useful and to identify possible mechanisms of BAL neutrophilia. In 60 patients with PCP, 15 fatalities or episodes of respiratory failure occurred, and 14 of these patients had greater than 5% BAL neutrophils. Only one of 33 patients with PCP and less than 5% BAL neutrophils died. In contrast, there was no correlation between survival and BAL neutrophil percentages in 33 patients who did not have PCP. Three patients with HIV infection without lung disease had normal BAL cell differentials. Intra-alveolar and interstitial leukocytes found in 17 transbronchial lung biopsies in patients with PCP indicate that the alveolar and interstitial compartments of the lung may be the source of BAL neutrophils. Pathologic evidence of increased severity of diffuse alveolar damage to explain BAL neutrophilia was not found. As BAL neutrophil percentages in PCP had both positive and negative predictive value, this information may be useful to stratify therapeutic trials or to identify the patient with PCP who is at high risk of a complicated or fatal outcome.
对96例有卡氏肺孢子虫肺炎（PCP）风险的患者（因人类免疫缺陷病毒（HIV）感染）的临床记录和支气管肺泡灌洗（BAL）细胞分类计数进行了分析，以确定该信息是否具有预后价值，并确定BAL中性粒细胞增多的可能机制。在60例PCP患者中，发生了15例死亡或呼吸衰竭事件，其中14例患者的BAL中性粒细胞大于5%。在33例BAL中性粒细胞小于5%的PCP患者中，只有1例死亡。相比之下，在33例未患PCP的患者中，生存率与BAL中性粒细胞百分比之间没有相关性。3例无肺部疾病的HIV感染患者的BAL细胞分类正常。在PCP患者的17次经支气管肺活检中发现的肺泡内和间质白细胞表明，肺的肺泡和间质部分可能是BAL中性粒细胞的来源。未发现弥漫性肺泡损伤严重程度增加以解释BAL中性粒细胞增多的病理证据。由于PCP中BAL中性粒细胞百分比具有阳性和阴性预测价值，该信息可能有助于对治疗试验进行分层或识别有复杂或致命结局高风险的PCP患者。
