Ekdahl K, Eriksson L, Rollof J, Miörner H, Griph H, Löfgren B
Department of Infectious Diseases, Lund University Hospital, Sweden.
Chest. 1993 Jun;103(6):1743-8. doi: 10.1378/chest.103.6.1743.
Fiberoptic bronchoscopy with bronchoalveolar lavage and protected specimen brush technique has become an established method for etiologic diagnosis in severe forms of pulmonary infections during recent years. In this study, including 62 bronchoscopies in 53 patients, a standardized program, covering all important pulmonary pathogens, has been evaluated in a heterogeneous group of patients. Results providing therapeutic guidelines were obtained in 53 percent (16/30) of the immunocompromised patients (including 5 bronchoscopies on HIV-positive patients), but only 19 percent (6/32) of the immunocompetent patients (p < 0.001). We conclude that bronchoscopy is of great value for diagnosing pulmonary infections in immunocompromised patients. In immunocompetent patients, the diagnostic yield is lower and the indication for bronchoscopy must be established for each individual patient based on clinical importance, resources, and risk. When bronchoscopy is performed, we believe that a standardized program like ours reduces the risk of missing important pathogens.
近年来，纤维支气管镜检查联合支气管肺泡灌洗术及保护性标本刷检技术已成为诊断重症肺部感染病因的常用方法。本研究纳入了53例患者的62次支气管镜检查，在一组异质性患者中评估了一个涵盖所有重要肺部病原体的标准化方案。免疫功能低下患者（包括对5例HIV阳性患者进行的支气管镜检查）中有53%（16/30）获得了能提供治疗指导的结果，而免疫功能正常患者中这一比例仅为19%（6/32）（p<0.001）。我们得出结论，支气管镜检查对诊断免疫功能低下患者的肺部感染具有重要价值。对于免疫功能正常的患者，诊断阳性率较低，必须根据临床重要性、资源和风险为每个患者确定支气管镜检查的适应证。当进行支气管镜检查时，我们认为像我们这样的标准化方案可降低遗漏重要病原体的风险。
