de Blic J, McKelvie P, Le Bourgeois M, Blanche S, Benoist M R, Scheinmann P
Service de Pneumologie et d'Allergologie Infantiles, Hôpital des Enfants Malades, Paris.
Thorax. 1987 Oct;42(10):759-65. doi: 10.1136/thx.42.10.759.
The diagnostic value of 73 bronchoalveolar lavages was assessed in 67 immunocompromised children (aged 3 months to 16 years) with pulmonary infiltrates. Thirty one children had primary and 19 secondary immune deficiency, 14 acquired immunodeficiency syndrome (AIDS), and three AIDS related complex. Bronchoalveolar lavage was performed during fibreoptic bronchoscopy, under local anaesthesia in all but two. One or more infective agents was found in eight of 11 patients with severe acute pneumonia and in 26 of 62 patients with interstitial pneumonitis. In interstitial pneumonitis, the most frequently encountered agents were Pneumocystis carinii (12), cytomegalovirus (8), and Aspergillus fumigatus (3). The yield was related to the severity of interstitial pneumonitis. The mean cellular count and cytological profile in lavage returns from patients with varying infective agents or underlying pathological conditions showed no significant difference, except in those children with AIDS and AIDS related complex who had appreciable lymphocytosis (mean percentage of lymphocytes 28 (SD 17]. In children with AIDS and chronic interstitial pneumonitis lymphocytosis without pneumocystis infection was observed in eight of nine bronchoalveolar lavage returns and was suggestive of pulmonary lymphoid hyperplasia. Finally, bronchoalveolar lavage produced a specific diagnosis from the microbiological or cytological findings in 44 instances (60%). Transient exacerbation of tachypnoea was observed in the most severely ill children but there was no case of respiratory decompensation attributable to the bronchoscopy. Bronchoalveolar lavage is a safe and rapid examination for the investigation of pulmonary infiltrates in immunocompromised children. It should be performed as a first line investigation and should reduce the use of open lung biopsy techniques.
对67例有肺部浸润的免疫功能低下儿童（年龄3个月至16岁）进行了73次支气管肺泡灌洗，以评估其诊断价值。31例儿童患有原发性免疫缺陷，19例患有继发性免疫缺陷，14例患有获得性免疫缺陷综合征（艾滋病），3例患有艾滋病相关综合征。除2例患者外，其余均在局部麻醉下于纤维支气管镜检查时进行支气管肺泡灌洗。在11例严重急性肺炎患者中有8例以及62例间质性肺炎患者中有26例发现了一种或多种感染因子。在间质性肺炎中，最常遇到的病原体是卡氏肺孢子虫（12例）、巨细胞病毒（8例）和烟曲霉（3例）。检出率与间质性肺炎的严重程度有关。不同感染因子或潜在病理状况患者灌洗回收液中的平均细胞计数和细胞学特征无显著差异，但艾滋病和艾滋病相关综合征患儿有明显的淋巴细胞增多（淋巴细胞平均百分比为28（标准差17））。在艾滋病合并慢性间质性肺炎的儿童中，9次支气管肺泡灌洗回收液中有8次观察到淋巴细胞增多且无肺孢子虫感染，提示肺淋巴样增生。最后，支气管肺泡灌洗根据微生物学或细胞学检查结果在44例（60%）中做出了明确诊断。在病情最严重的儿童中观察到呼吸急促短暂加重，但没有因支气管镜检查导致呼吸代偿失调的病例。支气管肺泡灌洗是一种安全、快速的检查方法，用于调查免疫功能低下儿童的肺部浸润情况。它应作为一线检查方法，并且应减少开胸肺活检技术的使用。
