Farrokhpour Mohsen, Kiani Arda, Mortaz Esmaeil, Taghavi Kimia, Farahbod Amir Masoud, Fakharian Atefeh, Kazempour-Dizaji Mehdi, Abedini Atefeh
Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Open Access Maced J Med Sci. 2019 Mar 27;7(6):913-919. doi: 10.3889/oamjms.2019.208. eCollection 2019 Mar 30.
Fiberoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) remains as the chief diagnostic tool in respiratory disorders. 1.2-16% of patients frequently experience fever after bronchoscopy. To exclude the need for multiple antibiotic prescribing in patients with post-bronchoscopy fever, the presence of the self-limiting inflammatory responses should be excluded.
The current study was conducted to test the serum of patients undergoing bronchoscopy for some proinflammatory cytokines including Tumor Necrosis Factor-alpha (TNF-ɑ), Interleukin-1beta (IL-1β), Interleukin-8 (IL-8) and Interleukin-6 (IL-6) and the value of Procalcitonin (PCT).
Current case-control study was conducted at the National Research Institute of Tuberculosis and Lung Disease in Iran. Nineteen patients (48.72%) that attended with a reasonable sign for a diagnostic bronchoscopy from January 2016 to December 2017 were included in the case group. The control group consisted of 20 patients who underwent a simple bronchoscopy and without FOB-BAL. The laboratory findings for PCT concentrations and cytokine levels in the three serum samples (before FOB-BAL (t0), after 6 hr. (t1), and at 24 hr. past (t2) FOB-BAL) were compared between two groups.
The frequency of post-bronchoscopy fever was 5.12, and the prevalence of post-bronchoscopy infectious fever was 2.56%. PCT level was considerably higher in the patient with a confirmed bacterial infection when compared to other participants (p-value < 0. 05). Interestingly, IL-8 level in the bacterial infection proven fever patient was higher than in other patients (p < 0.001). IL-8 levels displayed a specificity of 72.7% and a sensitivity of 100%, at the threshold point of 5.820 pg/ml. PCT levels had a specificity of 84% and a sensitivity of 81%, at the threshold point of 0.5 ng/ml.
The present findings show that in patients with fever after bronchoscopy, PCT levels and IL-8 levels are valuable indicators for antibiotic therapy, proving adequate proof for bacterial infection. The current findings also illustrate that to monitor the serum levels of PCT and proinflammatory cytokines in the patients undergoing FOB-BAL, the best time is the 24-hour postoperative bronchoscopy.
纤维支气管镜（FOB）引导下的支气管肺泡灌洗（BAL）仍然是呼吸系统疾病的主要诊断工具。1.2% - 16%的患者在支气管镜检查后经常出现发热。为了排除支气管镜检查后发热患者多次使用抗生素的必要性，应排除自限性炎症反应的存在。
本研究旨在检测接受支气管镜检查患者的血清中一些促炎细胞因子，包括肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-8（IL-8）和白细胞介素-6（IL-6）以及降钙素原（PCT）的值。
当前的病例对照研究在伊朗国家结核病和肺部疾病研究所进行。2016年1月至2017年12月因有合理指征接受诊断性支气管镜检查的19名患者（48.72%）被纳入病例组。对照组由20名接受简单支气管镜检查且未进行FOB - BAL的患者组成。比较两组在三个血清样本（FOB - BAL前（t0）、6小时后（t1）、FOB - BAL后24小时（t2））中PCT浓度和细胞因子水平的实验室检查结果。
支气管镜检查后发热的发生率为5.12%，支气管镜检查后感染性发热的患病率为2.56%。与其他参与者相比，确诊细菌感染患者的PCT水平显著更高（p值<0.05）。有趣的是，细菌感染确诊发热患者的IL - 8水平高于其他患者（p < 0.001）。在阈值点为5.820 pg/ml时，IL - 8水平的特异性为72.7%，敏感性为100%。在阈值点为0.5 ng/ml时，PCT水平的特异性为84%，敏感性为81%。
目前的研究结果表明，在支气管镜检查后发热的患者中，PCT水平和IL - 8水平是抗生素治疗的有价值指标，为细菌感染提供了充分证据。目前的研究结果还表明，对于接受FOB - BAL的患者，监测PCT和促炎细胞因子的血清水平，最佳时间是支气管镜检查术后24小时。
