Miller R F, Pugsley W B, Griffiths M H
Department of Medicine, University College London Medical School, UK.
Genitourin Med. 1995 Oct;71(5):280-5. doi: 10.1136/sti.71.5.280.
Open lung biopsy (OLB) is rarely necessary for investigation of HIV positive patients with acute respiratory episodes because of the high yield from fibreoptic bronchoscopy with bronchoalveolar lavage (BAL).
A retrospective review of OLB in HIV positive patients admitted to a specialist inpatient unit with acute respiratory symptoms was carried out in order to define clinical indications, diagnostic yield, impact on management, complications and outcome.
OLB was performed in 23 patients; 21 had undergone one or more bronchoscopies with BAL (5 also had negative results from transbronchial biopsy). Indications for OLB were: Group A, 15 patients thought clinically to have pneumocystis pneumonia but not responding to treatment; Group B, 4 patients with focal chest radiographic abnormalities; Group C, 4 patients with diffuse radiographic abnormalities and miscellaneous conditions. Preoperative PaO2 (on air) ranged from 4.4 to 14.5 (mean = 9.5) kPa. The results of OLB were in Group A 5 patients had non specific interstitial pneumonitis (NIP), 1 also had Kaposi's sarcoma, 4 had pneumocystis pneumonia (1 also had bronchiolitis obliterans organising pneumonia [BOOP]), 3 had Kaposi's sarcoma and 1 had BOOP and emphysema, 1 had pulmonary infarction and no infection and 1 had normal lung tissue. In Group B diagnoses were NIP, B cell lymphoma, occult alveolar haemorrhage and Pseudomonas aeruginosa pneumonia with BOOP; In Group C 2 patients had NIP and 2 had pneumocystis pneumonia (1 also had cytomegalovirus pneumonitis). All patients survived surgery and none required mechanical ventilation. OLB results significantly affected management; in Group A inappropriate treatment was discontinued in 11 patients found not to have pneumocystis pneumonia, and alternative therapy was begun in the 4 with pneumocystis and in Groups B and C 6 patients began specific therapy; unnecessary therapy was avoided in one and antimicrobial treatment was modified in one.
Open lung biopsy in HIV positive patients with focal and diffuse radiographic abnormalities has a high diagnostic yield and low morbidity. This investigation should be considered in those with acute respiratory episodes and negative results from bronchoscopic investigations or who have contra-indications to this procedure.
对于患有急性呼吸道疾病的HIV阳性患者，由于纤维支气管镜检查及支气管肺泡灌洗（BAL）的高诊断率，开放性肺活检（OLB）很少有必要进行。
对入住专科住院病房、有急性呼吸道症状的HIV阳性患者进行的OLB回顾性研究，以确定临床适应症、诊断率、对治疗的影响、并发症及预后。
23例患者接受了OLB；21例曾接受过一次或多次BAL支气管镜检查（5例经支气管活检结果也为阴性）。OLB的适应症为：A组，15例临床诊断为肺孢子菌肺炎但治疗无效的患者；B组，4例胸部X线有局灶性异常的患者；C组，4例胸部X线有弥漫性异常及其他病症的患者。术前静息状态下动脉血氧分压（PaO2）范围为4.4至14.5（平均9.5）kPa。OLB结果显示：A组中，5例为非特异性间质性肺炎（NIP），1例合并卡波西肉瘤，4例为肺孢子菌肺炎（1例合并机化性肺炎型细支气管炎[BOOP]），3例为卡波西肉瘤，1例为BOOP合并肺气肿，1例为肺梗死且无感染，1例肺组织正常。B组诊断为NIP、B细胞淋巴瘤、隐匿性肺泡出血及铜绿假单胞菌肺炎合并BOOP；C组中，2例为NIP，2例为肺孢子菌肺炎（1例合并巨细胞病毒性肺炎）。所有患者手术存活，无一例需要机械通气。OLB结果显著影响治疗；A组中，11例未患肺孢子菌肺炎的患者停止了不恰当治疗，4例患肺孢子菌肺炎的患者开始了替代治疗，B组和C组中6例患者开始了特异性治疗；1例避免了不必要的治疗，1例调整了抗菌治疗。
对于胸部X线有局灶性和弥漫性异常的HIV阳性患者，开放性肺活检诊断率高且发病率低。对于急性呼吸道疾病患者，支气管镜检查结果为阴性或有支气管镜检查禁忌症的患者，应考虑进行此项检查。
