Chamberlain D, Maurer J, Chaparro C, Idolor L
Department of Pathology, University of Toronto, Ontario, Canada.
J Heart Lung Transplant. 1994 Nov-Dec;13(6):963-71.
We investigated the utility of transbronchial lung biopsy in allograft evaluation, particularly with reference to rejection-mediated bronchiolitis obliterans in 105 transplant recipients surviving 3 months or more (29 single lung, 76 double lung). A sensitivity and specificity of one transbronchial biopsy procedure with an average procurement of 7.6 tissue fragments was 17.1% and 94.5%, respectively, according to results obtained from biopsies carried out after 2 months transplantation in 29 patients with confirmed rejection-mediated bronchiolitis obliterans and 61 patients known not to have the disease. The predictive value of a positive procedure for the presence of disease was 65.5% and that of a negative procedure for the absence of disease was 65.2%. Similarly, the sensitivity and specificity for the finding of bronchiolar mural fibrosis were 18.5% and 85.3%, respectively; and, for lymphocytic bronchiolitis, the values were 1.9% and 100%, respectively. We conclude that, although the sensitivity of transbronchial biopsy and the predictive value of a procedure which shows microscopic bronchiolitis obliterans are low, attempts should be made to support a clinical diagnosis of bronchiolitis obliterans through biopsy, given the problems inherent in achieving an early and certain diagnosis according to clinical criteria alone.
我们研究了经支气管肺活检在同种异体移植评估中的效用，特别是针对105例存活3个月或更长时间的移植受者（29例单肺移植，76例双肺移植）中由排斥反应介导的闭塞性细支气管炎。根据对29例确诊为排斥反应介导的闭塞性细支气管炎的患者和61例已知无此病的患者在移植后2个月进行活检所获得的结果，平均获取7.6个组织碎片的一次经支气管活检程序的敏感性和特异性分别为17.1%和94.5%。阳性程序对疾病存在的预测值为65.5%，阴性程序对疾病不存在的预测值为65.2%。同样，细支气管壁纤维化的发现的敏感性和特异性分别为18.5%和85.3%；对于淋巴细胞性细支气管炎，其值分别为1.9%和100%。我们得出结论，尽管经支气管活检的敏感性以及显示显微镜下闭塞性细支气管炎的程序的预测值较低，但鉴于仅根据临床标准实现早期和确切诊断存在固有问题，仍应尝试通过活检来支持闭塞性细支气管炎的临床诊断。
