Sydney Children's Hospital Network NSW, Australia.
Sydney Children's Hospital Network Randwick NSW, The University of New South Wales Sydney, Australia.
Paediatr Respir Rev. 2020 Apr;34:24-34. doi: 10.1016/j.prrv.2020.02.003. Epub 2020 Feb 29.
The objective of this study was to describe the diagnostic yield and safety of bronchoalveolar lavage (BAL) in the evaluation of pulmonary lesions in immunocompromised children.
We conducted a systematic review of literature published during the past 20 years, searching Medline, Medline EPub, EMBASE, and Scopus. Studies included involved paediatric patients (<18 years) on treatment for an oncological diagnosis or other immune compromise who underwent BAL for evaluation of pulmonary lesions. Only English language publications were included.
In all, 272 studies were screened and 19 included. All were observational studies with moderate (11/19) or serious (8/19) risk of bias. BAL yielded a potential pathogen in 43% of cases (496/1156). Two papers reported improved diagnostic yield with early BAL (less than 3 days of presentation). A change in patient management after BAL was reported in 53% of cases (275/519). Adverse events were reported in 19% of cases following BAL (193/993) but were generally mild with no procedure-related mortality reported.
BAL appears to be useful for evaluation of pulmonary lesions in immunocompromised children with generally acceptable safety, though included studies had at least moderate risk of bias. Future prospective studies may provide more definitive estimates of benefit, timing and risk of BAL in this population.
本研究旨在描述支气管肺泡灌洗（BAL）在评估免疫功能低下儿童肺部病变中的诊断效果和安全性。
我们对过去 20 年发表的文献进行了系统综述，检索了 Medline、Medline EPub、EMBASE 和 Scopus。研究纳入了接受支气管肺泡灌洗以评估肺部病变的接受肿瘤治疗或其他免疫抑制治疗的儿科患者（<18 岁）。仅纳入英文出版物。
共筛选了 272 篇研究，纳入了 19 篇。所有研究均为观察性研究，具有中度（11/19）或严重（8/19）的偏倚风险。BAL 在 43%的病例（496/1156）中发现了潜在病原体。有 2 篇论文报告了早期 BAL（就诊后<3 天）可提高诊断效果。在 53%的病例（275/519）中，BAL 后改变了患者的治疗方案。BAL 后有 19%的病例（193/993）发生了不良事件，但通常为轻度，无与操作相关的死亡报告。
BAL 似乎可用于评估免疫功能低下儿童的肺部病变，具有可接受的安全性，但纳入的研究存在至少中度的偏倚风险。未来的前瞻性研究可能会提供更明确的关于该人群中 BAL 的获益、时机和风险的估计。
