气管镜对实体器官移植患者肺部机会性感染的病原学诊断价值

Pathogenic analysis of solid organ transplant recipients with pulmonary opportunistic infections via bronchoscopy

目的评估支气管镜检查对实体器官移植患者肺部机会性感染的诊断性应用价值。方法从2006年11月至2011年9月，天津市第一中心医院对114例器官移植患者共进行了117次支气管镜检查，包括支气管肺泡灌洗和防污染毛刷，进行支气管镜检查的指征为可疑肺部感染。观察支气管镜下的表现，同时对标本的病原菌谱进行分析，包括细菌、巨细胞病毒、肺孢子菌、结核分枝杆菌和其他真菌。结果63例通过支气管镜获得了明确的病原学诊断（53．8％），机会性感染是最常见的病因，共56例，占88．9％，（其中2种机会性混合感染7例），肺孢子菌36例，巨细胞病毒24例，结核分枝杆菌3例。细菌性感染共16例，占25．9％（其中9例为合并机会性混合感染），细菌谱中主要为革兰阴性杆菌。所有患者中共有45例根据病原学诊断结果更改了抗生素的使用。结论支气管镜检查对可疑肺部感染的器官移植患者的病原学诊断是一种极为有效的方法，特别对机会性感染的诊断尤为重要，诊断结果可以指导医师针对性的使用抗生素。

Objective To evaluate the diagnostic utihty of bronchoscopy in solid organ transplant recipients with pulmonary opportunistic infections. Methods From December 2006 to September 2011, 117 cases of bronchoscopy with protected specimen brush and bronchoalveolar lavage were performed in 114 solid organ transplant recipients at Tianjin First Central Hospital. The indication for bronchoscopy was suspected pulmonary infections. The bronchoscopic manifestations were described and the specimens analyzed with regards to bacteriology, cytomegalovirus, P carinii, mycobacterium tuberculosis and other fungal cultures. Results A definite infectious etiology was confirmed in 63 patients （53.8%）. And opportunistic infections were the most frequent etiology （56/63, 88. 9% including 7 cases with two mixed opportunistic infections）. Among 63 pathogens, P carinii was demonstrated in 36 episodes, cytomegalovirus in 24 episodes and mycobacterium tuberculosis in 3 episodes. Bacterial infections （mainly Gram-negative） accounted for 16 of 63 episodes （25.9% including 9 cases with mixed opportunistic/bacterial infection）. In accordance with the diagnostic results, antibiotic treatment was changed in 45 cases. Conclusions As an extremely useful tool, bronchoscopy is of great value for pathogenic detection in transplant recipients with suspected pulmonary infections, especially for opportunistic infections. And the bronchoscopic findings may guide targeted antimicrobial therapy.