有和无血液系统恶性肿瘤患者的肺部感染：可弯曲支气管镜检查的诊断率及安全性——一项回顾性分析

Pulmonary infections in patients with and without hematological malignancies: diagnostic yield and safety of flexible bronchoscopy-a retrospective analysis.

作者信息

Panse Jens, von Schwanewede Kai, Jost Edgar, Dreher Michael, Müller Tobias

机构信息

Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.

Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.

出版信息

J Thorac Dis. 2020 Sep;12(9):4860-4867. doi: 10.21037/jtd-20-835.

DOI:10.21037/jtd-20-835

PMID:33145059

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7578490/

Abstract

BACKGROUND

Fiberoptic bronchoscopy (FOB) with broncho-alveolar lavage (BAL) is frequently performed in patients with hematological malignancies and pulmonary opacities. While the safety of the procedure in this patient population has been shown, data about the diagnostic yield widely differ between studies. Furthermore, data comparing diagnostic yield and safety of flexible bronchoscopy to narrow sources of pulmonary infections in patients with and without underlying hematological malignancy are lacking.

METHODS

We carried out a retrospective analysis of bronchoscopies done for the diagnostic work-up of pulmonary infections. Diagnostic yield and the occurrence of complications in patients with and without hematological disease were compared.

RESULTS

In total n=268 bronchoscopies were done in patients suffering from a hematological malignancy (HM) compared to n=408 bronchoscopies in patients without hematological malignancy (NHM). The overall diagnostic yield was similar and did not differ between the groups (HM: 67.2% NHM: 64.7%; P=0.5622). However, when cultures positive for Candida were not considered as clinically relevant diagnostic yield was higher in the HM group (HM: 62.7% NHM: 53.9%; P=0.0261) due to a higher detection rate of fungi and viruses (both P<0.001). Interestingly, the diagnostic yield for bacteria was not decreased by pre-treatment with antibiotics in either group (both P>0.05). There was no difference in the complication rate between the groups and most complications were considered as minor.

CONCLUSIONS

In summary, our data demonstrate similar diagnostic yield and safety of flexible bronchoscopy for diagnosing pulmonary infection in patients with and without underlying hematological malignancy.

摘要

背景

对于血液系统恶性肿瘤合并肺部阴影的患者，常进行纤维支气管镜检查（FOB）及支气管肺泡灌洗（BAL）。虽然该操作在这一患者群体中的安全性已得到证实，但不同研究关于其诊断率的数据差异很大。此外，缺乏比较有或无潜在血液系统恶性肿瘤患者中，柔性支气管镜对于明确肺部感染窄谱病原体的诊断率和安全性的数据。

方法

我们对为诊断肺部感染而进行的支气管镜检查进行了回顾性分析。比较了有或无血液系统疾病患者的诊断率及并发症发生情况。

结果

患有血液系统恶性肿瘤（HM）的患者共进行了n = 268例支气管镜检查，而无血液系统恶性肿瘤（NHM）的患者进行了n = 408例支气管镜检查。总体诊断率相似，两组之间无差异（HM：67.2%，NHM：64.7%；P = 0.5622）。然而，当不将念珠菌培养阳性视为具有临床意义的诊断结果时，HM组的诊断率更高（HM：62.7%，NHM：53.9%；P = 0.0261），这是因为真菌和病毒的检出率更高（两者P < 0.001）。有趣的是，两组中抗生素预处理均未降低细菌的诊断率（两者P > 0.05）。两组之间的并发症发生率无差异，且大多数并发症被认为是轻微的。