Haverkos H W, Dowling J N, Pasculle A W, Myerowitz R L, Lerberg D B, Hakala T R
Cancer. 1983 Sep 15;52(6):1093-7. doi: 10.1002/1097-0142(19830915)52:6<1093::aid-cncr2820520627>3.0.co;2-4.
The records of 59 immunocompromised patients with fever and pulmonary infiltrates who underwent open lung biopsy, were reviewed. A specific diagnosis was made by lung biopsy in 49 (83%) patients, and in 32 instances (54%) the diagnosis was a treatable infection. Only two (3.4%) false-negative biopsies occurred. Transplant recipients were more likely to have a specific, treatable pneumonia (74%) than patients with a reticuloendothelial malignancy (42%, P less than 0.05). This was due to a greater frequency of bacterial pneumonias, primarily due to Legionella, in transplant recipients (P less than 0.01). However, obtaining a specific diagnosis by lung biopsy did not appear to improve outcome. Seventeen of 32 (53%) patients with treatable infections survived, compared to 8 of 16 (50%) with specific, but untreatable, diagnosis and 6 of 11 (55%) with nondiagnostic biopsies. Advanced age and a low platelet count were predictive of death in both transplant recipients and patients with leukemia and lymphoma (P less than 0.05); a high serum creatinine was an additional predictor in renal transplant recipients.
对59例有发热和肺部浸润且接受了开胸肺活检的免疫功能低下患者的记录进行了回顾。49例（83%）患者通过肺活检做出了明确诊断，其中32例（54%）诊断为可治疗的感染。仅出现2例（3.4%）假阴性活检。移植受者比患有网状内皮系统恶性肿瘤的患者更有可能患明确的、可治疗的肺炎（74%对42%，P<0.05）。这是因为移植受者中细菌性肺炎的发生率更高，主要是由军团菌引起（P<0.01）。然而，通过肺活检获得明确诊断似乎并未改善预后。32例可治疗感染患者中有17例（53%）存活，相比之下，16例有明确但不可治疗诊断的患者中有8例（50%）存活，11例活检未明确诊断的患者中有6例（55%）存活。高龄和低血小板计数是移植受者以及白血病和淋巴瘤患者死亡的预测因素（P<0.05）；高血清肌酐是肾移植受者死亡的另一个预测因素。
