Campbell J H, Blessing N, Burnett A K, Stevenson R D
Department of Respiratory Medicine, Glasgow Royal Infirmary.
Thorax. 1993 Dec;48(12):1248-51. doi: 10.1136/thx.48.12.1248.
Although pulmonary infiltrates are common in bone marrow transplant recipients and add significantly to the morbidity and mortality of this group of patients, there is uncertainty as to the most appropriate investigation and a lack of information on the effects of investigations on management and outcome.
All bone marrow transplant recipients from one institution referred for respiratory investigation between 1982 and 1990 were reviewed.
Of 204 bone marrow transplant recipients 27 developed pulmonary infiltrates which failed to respond to broad spectrum antibiotics. All were examined by bronchoscopy and bronchoalveolar lavage. A specific diagnosis was made in 20 cases, 17 with an infective cause and three with a non-infective aetiology. In 17 of the 27 episodes these investigations led to a positive change in treatment, but in only five did these changes result in patient survival beyond one month. Eighteen of the 20 deaths were due to progressive respiratory failure of an infective aetiology in 14 and non-infective in four.
Bronchoscopy and bronchoalveolar lavage are effective in establishing a diagnosis, but the impact on overall survival is disappointingly poor.
尽管肺部浸润在骨髓移植受者中很常见，且显著增加了该组患者的发病率和死亡率，但对于最合适的检查方法仍存在不确定性，并且缺乏关于检查对治疗和预后影响的信息。
回顾了1982年至1990年间一所机构中所有因呼吸问题接受检查的骨髓移植受者。
在204名骨髓移植受者中，27人出现肺部浸润，对广谱抗生素无反应。所有患者均接受了支气管镜检查和支气管肺泡灌洗。20例作出了明确诊断，17例为感染性病因，3例为非感染性病因。在27次发病中的17次，这些检查导致了治疗上的积极改变，但只有5次这些改变使患者存活超过1个月。20例死亡中有18例是由于感染性病因导致的进行性呼吸衰竭（14例）和非感染性病因导致的进行性呼吸衰竭（4例）。
支气管镜检查和支气管肺泡灌洗在确立诊断方面是有效的，但对总体生存的影响令人失望地差。
