Chang Shu-Luen, Tsai Han-Chen, Lin Fang-Chi, Chao Hang-Sheng, Chou Chung-Wei, Chang Shi-Chuan
Department of internal Medicine, National Yang-Ming University Hospital, Yi-Lan.
J Thorac Dis. 2020 Jun;12(6):3125-3134. doi: 10.21037/jtd-19-3659.
Bronchoalveolar lavage (BAL) is a useful tool in the diagnostic work-up of patients with interstitial lung diseases (ILDs). In this prospective study, we investigated the clinical usefulness of BAL in patients with ILD radiographically.
The enrolled patients were classified into outpatient department (OPD), and inpatients groups who was admitted to general ward (GW) or intensive care unit (ICU) groups based on the time when BAL done. The clinical usefulness of BAL was defined as a new diagnosis established and/or treatment significantly changed. The clinical usefulness of BAL among the three groups of patients and the patients divided by underlying diseases was compared using the χ test with or without Fisher's exact test.
Among our 184 patients, there were 37 in OPD group, 86 in GW group and 61 in ICU group. The final diagnoses were infectious in 23, non-infectious in 102, mixed etiologies in 19, and non-diagnostic in 40 patients. The diagnostic yields (revised diagnosis after BAL) of BAL among ICU patients, GW patients and OPD patients were 60.6%, 69.7% and 21.6%, respectively (P<0.001), and was 57.1% in total patients. The diagnostic yields of BAL among patients with cancer, organ transplantation and collagen vascular disease were statistically different (P=0.009).
BAL is of use in establishing a diagnosis of ILD and is mandatary especially in the admitted patients with ILD because diagnostic yield was relatively higher in admitted patients than in OPD patients. In addition, BAL should be done more early in the admitted patients with malignancy, stem cell and/or organ transplantation and collagen vascular disease especially when they showed poor response to initial medications.
支气管肺泡灌洗（BAL）是间质性肺疾病（ILD）患者诊断检查中的一项有用工具。在这项前瞻性研究中，我们通过影像学研究了BAL在ILD患者中的临床实用性。
根据进行BAL的时间，将纳入的患者分为门诊（OPD）组、入住普通病房（GW）的住院患者组和重症监护病房（ICU）组。BAL的临床实用性定义为确立新诊断和/或显著改变治疗方案。使用χ检验（有或没有Fisher精确检验）比较三组患者以及按基础疾病划分的患者中BAL的临床实用性。
在我们的184例患者中，OPD组有37例，GW组有86例，ICU组有61例。最终诊断为感染性疾病的有23例，非感染性疾病的有102例，病因混合的有19例，未明确诊断的有40例。ICU患者、GW患者和OPD患者中BAL的诊断率（BAL后修正诊断）分别为60.6%、69.7%和21.6%（P<0.001），总体患者中的诊断率为57.1%。癌症、器官移植和胶原血管病患者中BAL的诊断率有统计学差异（P = 0.009）。
BAL有助于ILD的诊断，对于住院的ILD患者尤为必要，因为住院患者的诊断率相对高于OPD患者。此外，对于患有恶性肿瘤、干细胞和/或器官移植以及胶原血管病的住院患者，尤其是对初始治疗反应不佳时，应尽早进行BAL。
