Girgis R E, Reichenspurner H, Robbins R C, Reitz B A, Theodore J
Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, California 94305-5236, USA.
Transplantation. 1995 Dec 27;60(12):1458-61. doi: 10.1097/00007890-199560120-00015.
Bronchoscopy with transbronchial biopsy (TBBx) and bronchoalveolar lavage (BAL) has an appreciable yield in detecting asymptomatic abnormalities in heart-lung transplant recipients (HLTR) during the early postoperative period. The utility of annual surveillance procedures has not been critically evaluated. We reviewed all annual bronchoscopies performed on 29 HLTR to determine the frequency of asymptomatic abnormalities. Surveillance bronchoscopies (SB) were performed on asymptomatic subjects with unchanged lung function compared with baseline. Surveillance/clinical bronchoscopies (SCB) were those performed in patients with stable decrements in lung function. Nineteen patients underwent 48 SB and 8 had 18 SCB. Five of 15 (33%) SB performed at one year yielded an abnormal TBBx (1 grade 2 acute rejection [AR], 1 grade 1 AR, 1 grade 1 AR with obliterative bronchiolitis [OB] and 2 Pneumocystis carinii pneumonia). At 2 or more years, TBBx was abnormal in 2 of 33 (6%, p = 0.024 compared with first year TBBx) (1 grade 1 AR, 1 lymphocytic bronchiolitis). Pathogens were identified in BAL in 19 (40%) SB. Fourteen (78%) SCB were abnormal. Nine (50%) revealed an abnormal TBBx (all OB), but only 2 (11%) of these altered patient management. Seven (39%) demonstrated pathogens in BAL. We conclude that in HLTR (1) surveillance TBBx rarely yields positive findings 2 or more years posttransplant, (2) surveillance TBBx seldom alters management in patients with stable decrements in lung function, and (3) BAL is useful to screen for potential pathogens.
经支气管活检（TBBx）和支气管肺泡灌洗（BAL）的支气管镜检查在检测心肺移植受者（HLTR）术后早期无症状异常方面有显著收获。年度监测程序的效用尚未得到严格评估。我们回顾了对29例HLTR进行的所有年度支气管镜检查，以确定无症状异常的发生率。对肺功能与基线相比无变化的无症状受试者进行监测支气管镜检查（SB）。监测/临床支气管镜检查（SCB）是对肺功能稳定下降的患者进行的检查。19例患者接受了48次SB检查，8例患者接受了18次SCB检查。在术后1年进行的15次SB检查中，有5次（33%）TBBx结果异常（1例2级急性排斥反应[AR]，1例1级AR，1例伴有闭塞性细支气管炎[OB]的1级AR，2例卡氏肺孢子虫肺炎）。在术后2年或更长时间，33次SB检查中有2次（6%，与第一年TBBx相比p = 0.024）TBBx结果异常（1例1级AR，1例淋巴细胞性细支气管炎）。在19次（40%）SB检查的BAL中发现了病原体。14次（78%）SCB检查结果异常。9次（50%）显示TBBx结果异常（均为OB），但其中只有2次（11%）改变了患者的治疗方案。7次（39%）在BAL中发现了病原体。我们得出结论，在HLTR中：（1）移植后2年或更长时间的监测TBBx很少有阳性结果；（2）监测TBBx很少改变肺功能稳定下降患者的治疗方案；（3）BAL有助于筛查潜在病原体。
