Morton Christopher, Puchalski Jonathan
Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.
J Thorac Dis. 2019 Dec;11(12):5603-5612. doi: 10.21037/jtd.2019.09.72.
Bronchoscopy is an important tool for the diagnosis of pulmonary disorders in immunocompromised patients. The addition of biopsies to bronchoalveolar lavage improves the diagnostic yield of non-infectious etiologies, although the underlying etiology of the immunocompromised state must be considered and may be influential. Certain unknowns remain, including timing of bronchoscopy and its impact on medical management and mortality. The ongoing role of non-invasive testing for infectious complications prior to bronchoscopy also remains to be defined. This review addresses the role of bronchoscopy in immunocompromised states related to underlying hematologic malignancies, prescription drug use or chemotherapy, and other disorders that predispose patients to infectious or non-infectious pulmonary diseases.
支气管镜检查是诊断免疫功能低下患者肺部疾病的重要工具。在支气管肺泡灌洗的基础上增加活检可提高非感染性病因的诊断率,不过必须考虑免疫功能低下状态的潜在病因,其可能具有影响作用。仍存在一些未知因素,包括支气管镜检查的时机及其对医疗管理和死亡率的影响。支气管镜检查前针对感染性并发症的非侵入性检测的持续作用也有待明确。本综述探讨了支气管镜检查在与潜在血液系统恶性肿瘤、处方药使用或化疗以及其他使患者易患感染性或非感染性肺部疾病的病症相关的免疫功能低下状态中的作用。