Cazzadori A, Di Perri G, Todeschini G, Luzzati R, Boschiero L, Perona G, Concia E
Endoscopy Unit, University of Verona, Italy.
Chest. 1995 Jan;107(1):101-6. doi: 10.1378/chest.107.1.101.
Bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) frequently are performed in the investigation of immunocompromised patients with lung disorders. The risk-benefit ratio of TBB currently is debated, since several authors have found that the less invasive BAL may provide as much information as TBB, with the avoidance of some biopsy-related side effects. We retrospectively evaluated 157 instances of bronchoscopy carried out on 142 immunocompromised patients, with both BAL and TBB performed in every case. Immunosuppressant conditions were HIV infection (79), hematologic malignancies (36), and antirejection therapy in renal transplant recipients (27). Transbronchial biopsy provided a diagnostic yield significantly higher than that obtained by BAL in all categories investigated; diagnostic rates were 77.3% for TBB and 47.6% for BAL (p < 0.001) in patients with HIV infection, 55 and 20% (p < 0.001) in patients with hematologic malignancies, and 57.5 and 27.2% (p < 0.001) in renal transplant recipients. Looking at the whole series, the diagnostic rates of TBB and BAL were 67.5 and 36.3%, respectively (p < 0.001), with a total additional yield of 33% provided by TBB, while in only 2% of cases BAL gave rise to diagnostic information not achieved by TBB. Considering that side effects followed TBB at a negligible rate (2.5%), we believe that TBB should be routinely carried out in these patients once the diagnostic strategy has been oriented to bronchoscopy.
支气管肺泡灌洗（BAL）和经支气管活检（TBB）常用于免疫功能低下的肺部疾病患者的检查。目前TBB的风险效益比存在争议，因为一些作者发现侵入性较小的BAL可能提供与TBB一样多的信息，同时避免了一些活检相关的副作用。我们回顾性评估了142例免疫功能低下患者进行的157例支气管镜检查，每例均同时进行了BAL和TBB。免疫抑制情况包括HIV感染（79例）、血液系统恶性肿瘤（36例）和肾移植受者的抗排斥治疗（27例）。在所有研究类别中，经支气管活检的诊断率显著高于BAL；HIV感染患者中，TBB的诊断率为77.3%，BAL为47.6%（p<0.001）；血液系统恶性肿瘤患者中，诊断率分别为55%和20%（p<0.001）；肾移植受者中，诊断率分别为57.5%和27.2%（p<0.001）。从整个系列来看，TBB和BAL的诊断率分别为67.5%和36.3%（p<0.001），TBB的总额外诊断率为33%，而只有2%的病例中BAL提供了TBB未获得的诊断信息。考虑到TBB后的副作用发生率可忽略不计（2.5%），我们认为一旦诊断策略确定为支气管镜检查，这些患者应常规进行TBB。
