纤维支气管镜及支气管肺泡灌洗在免疫损害宿主肺部病变诊断中的应用

Use of Fiberoptic Bronchoscopy and Bronchoalveolar Lavage in Immunocompromised Patients with Lung Infiltrates

目的探讨纤维支气管镜(纤支镜)及支气管肺泡灌洗(BAL)在免疫损害宿主肺部病变中的诊断价值及并发症。方法收集31例免疫损害宿主因肺部病变行纤支镜检查的临床资料以及BALF病原学检查结果。除常规的微生物检查外,采用分子检测方法检测巨细胞病毒以及呼吸道病毒。结果所有病例均进行了BAL,纤支镜总的诊断率为65%,且在感染性疾病中的诊断率较非感染性疾病为高,分别为86%和25%。通过分子检测发现4例巨细胞病毒和3例呼吸道病毒感染病例。结论纤支镜及BAL对于明确免疫损害宿主肺部病变的病因是有效和安全的。分子检测可帮助提高诊断率。

Objective To investigate the diagnostic value and complications of fibrobronehoscopy and bronchoalveolar lavage in immunocompromised patients with pulmonary infiltrates. Methods Fiberoptic bronchoscopy was performed in 31 immunoeompromised patients. The clinical data and results of bronchoalveolar lavage were collected. In addition to conventional microbiological methods, molecular detection for cytomegalovirus （CMV） and respiratory viruses were performed. Results In all cases BAL was performed. The overall diagnostic yield of fibrobronchoscopy was 65%. The diagnosis was more likely to be established by fibrobronchoscopy when the lung infiltrate was due to an infectious agent （ 86% ） than to a noninfectious process（25% ）. By molecular detection, CMV was identified in 4 cases, and other respiratory viruses were identified in 3 cases. Fever （23%） was the most common complication. Conclusions Fibrobronchoscopy and BAL are effective and safe for the diagnosis of pulmonary infiltrates in immunocompromised patients. The molecular technique may help to enhance the diagnostic yield of BAL.