纤维支气管镜及支气管肺泡灌洗检查对免疫功能低下合并肺炎病原学诊断价值

Value of Bronchoscopy and Bronchoalveolar Lavage in Etiologic Diagnosis of Immunocompromised Patients with Pneumonia

目的探讨纤维支气管镜及支气管肺泡灌洗(BAL)对免疫功能低下合并肺炎病原学诊断的意义。方法回顾分析近年来医院免疫功能低下合并肺炎行纤维支气管镜检查的36例患者的临床资料,及纤维支气管镜检查和支气管肺泡灌洗液(BALF)病原学检查结果。结果经纤维支气管镜和(或)BAL检测61.1%的患者可确定感染病原体,同时进行外周血和BALF巨细胞病毒(CMV)定量PCR检测19例,阳性率分别为14.3%和42.9%(P<0.05),同时行BALF CMV定量PCR和外周血CMV IgM检测15例,阳性率分别为47.1%和5.9%(P<0.05);经各种方法诊断CMV肺炎共9例,其中8例经BALF中CMV定量PCR检测确定,经纤维支气管镜取分泌物或BALF培养总阳性率50.0%;同时行分泌物和BALF培养的患者中,分泌物和BALF真菌培养阳性率分别为14.3%和42.9%,细菌培养阳性率均为28.6%,1例患者BALF检测卡氏肺囊虫阳性。结论纤维支气管镜及支气管肺泡灌洗对免疫功能低下合并肺炎的病原学诊断有较高价值,有助于早期明确诊断和指导治疗。

OBJECTIVE To investigate the value of fibrobronchoscopy and bronchoalveolar lavage in etiologic diagnosis of pneumonia in immunocompromised patients. METHODS The clinical document and results of fibrobronchoscopy and bronchoalveolar lavage in 36 immunocompromised patients with pneumonia were retrospectively analyzed, whose conditions were mainly after organ transplantation and hematologic neoplasia. RESULTS Through fibrobronchoscopy and （or） bronchoalveolar lavage, 22 cases （61. 1%） were etiologically diagnosed. In 19 cases taking cytomegalovirus（CMV） quantitative PCR test of both peripheral blood and BALF, the positive rate of blood and BALF was 14.3% and 42.9%, respectively （P〈0.05）. In 15 cases taking both CMV quantitive PCR test of BALF and CMV IgM test of peripheral blood, the positive rate of which was 47.1% and 5.9%, respectively （P〈0.05）. Nine cases were diagnosed as CMV pneumonia and 8 of them were diagnosed by quantitative PCR test of BALF. The culture of sampling via fibrobronchoscopy or bronchoalveolar lavage was positive in 18 cases （positive rate 50%）. In 7 cases taking bronchial secretion via fibrochoscopy and BALF fungi culture at the same time, the positive rate was 14.3% and 42.9%, respectively. The positive rate of bacterium culture with secretion and BALF were both 28. 6%. Pneumocystis carinii was found in BALF of 1 case. CONCLUSIONS Fibrobronchoscopy and bronchoalveolar lavage are valuable in etiologic diagnosis of immunocompromised patients with pneumonia.