White P, Bonacum J T, Miller C B
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2196, USA.
Bone Marrow Transplant. 1997 Oct;20(8):681-7. doi: 10.1038/sj.bmt.1700957.
Fiberoptic bronchoscopy (FOB) has been reported to have a high diagnostic yield and to be safe in BMT patients with pulmonary infiltrates. At our institution, BMT patients with respiratory symptoms and/or pulmonary infiltrates had a thoracic CT and bronchoalveolar lavage (BAL). Transbronchial biopsy (TBBx) was considered if the platelet count could be raised to >30 x 10(9)/l. From March 1993 to August 1995, 52 patients had 68 FOBs (42 BAL + TBBx, 26 BAL only) for 60 episodes of clinical pneumonia. Patients' characteristics were: 38 males, mean age 42 years, and 39 allogeneic BMTs. Of the 68 FOBs, 47 were performed to evaluate diffuse infiltrates, 10 were done on mechanically ventilated patients, and 50 of the FOBs were preceded by a platelet transfusion. Thirty-one percent of FOBs (21 FOBs, 19 patients) were diagnostic. Twenty-four percent of FOBs (11 diagnostic FOBs, six nondiagnostic FOBs) changed therapy. Ten complications (15%) occurred in 10 FOBs (five acute respiratory failure, three pneumothoraces, one nose bleed, one death). Hospital and 6-month survival based on episodes of clinical pneumonia were 47 and 32%, respectively. Patients who had a diagnostic FOB or a FOB that changed treatment did not have better hospital or 6-month survival compared to patients who had FOBs that were nondiagnostic or did not change treatment. FOB in our BMT patient population, had a low diagnostic yield (31%), infrequently changed treatment (24%), a significant complication rate (15%) and was not associated with improved patient survival. The role of routine diagnostic FOB in BMT patients with pulmonary infiltrates and/or respiratory symptoms should be reevaluated.
据报道，纤维支气管镜检查（FOB）对骨髓移植（BMT）合并肺部浸润的患者具有较高的诊断率且安全性良好。在我们机构，有呼吸道症状和/或肺部浸润的BMT患者会接受胸部CT和支气管肺泡灌洗（BAL）检查。若血小板计数能升至>30×10⁹/L，则考虑进行经支气管活检（TBBx）。1993年3月至1995年8月，52例患者因60次临床肺炎发作接受了68次FOB检查（42次BAL + TBBx，26次仅BAL）。患者特征为：38例男性，平均年龄42岁，39例接受异基因BMT。在68次FOB检查中，47次用于评估弥漫性浸润，10次针对机械通气患者，50次FOB检查前进行了血小板输注。31%的FOB检查（21次FOB检查，19例患者）具有诊断价值。24%的FOB检查（11次诊断性FOB检查，6次非诊断性FOB检查）改变了治疗方案。10次FOB检查出现了10例并发症（15%）（5例急性呼吸衰竭，3例气胸，1例鼻出血，1例死亡）。基于临床肺炎发作情况的住院生存率和6个月生存率分别为47%和32%。与FOB检查未得出诊断结果或未改变治疗方案的患者相比，接受了诊断性FOB检查或检查改变了治疗方案的患者，其住院生存率或6个月生存率并无改善。在我们的BMT患者群体中，FOB检查的诊断率较低（31%），很少改变治疗方案（24%），并发症发生率较高（15%），且与患者生存率的提高无关。对于有肺部浸润和/或呼吸道症状的BMT患者，常规诊断性FOB检查的作用应重新评估。
