支气管镜在风湿免疫病伴肺部异常患者中获取微生物的影响因素研究  

Diagnostic Yield of Bronchoscopy in Obtaining Microorganisms in Patients with Rheumatic Autoimmune Disease and Pulmonary Abnormality: Influencing Factors Analysis

作　　者：孙雪峰[1] 留永健[1] 肖毅[1] 许文兵[1] 

机构地区：[1]北京协和医院呼吸内科,北京100730

出　　处：《中国呼吸与危重监护杂志》2014年第3期277-280,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家十二五科技支撑计划(编号:2012BAI05B02)

摘　　要：目的肺部感染在风湿免疫病患者中常见,支气管镜下检查有助于更好获取微生物,但支气管镜检查存在风险。通过对风湿免疫病合并肺部异常患者中支气管镜下获取微生物的影响因素进行研究,以期提高检查阳性率。方法回顾性分析2009年1月至2013年6月期间北京协和医院风湿免疫科收治的风湿免疫病合并肺部异常并行支气管镜检查以获取微生物的患者。采集患者特征、临床症状、用药史、实验室检查、影像表现和检查所在肺叶等资料。结果共87例患者接受91例次支气管镜检查,包括72例肺泡灌洗,21例支气管吸取和72例毛刷,总阳性率为52.7%,支气管吸取物的阳性率为71.4%,肺泡灌洗液的阳性率为38.9%,毛刷阳性率为18.1%。伴有发热、咳嗽或咳痰等临床症状的风湿免疫病患者较无此症状的患者微生物检查阳性率更高(60.0%%比34.6%,P=0.028);胸部CT表现为结节、团块或实变的患者较表现为网格、索条或磨玻璃影的患者具有更高的阳性率(61.8%比26.1%,P=0.003)。灌洗部位对诊断阳性率无显著影响(P=0.691)。结论伴有发热、咳嗽或咳痰等临床症状以及胸部CT表现为结节、团块或实变的风湿免疫病患者支气管镜下获取微生物的阳性率更高。Objective Pulmonary infection is commonly seen in patients with rheumaticautoimmune disease （ RAD） . Sometimes bronchoscopy is used to obtain microorganisms. In order to improvediagnostic yield, the factors affecting diagnostic yield of bronchoscopy in obtaining microorganisms in RADpatients with pulmonary abnormality were analyzed retrospectively.Methods A retrospective study wasperformed in RAD patients with lung infiltrates who received bronchoscopy for obtaining microorganisms atthe Department of Rheumatology, Peking Union Medical College Hospital from January 2009 to June 2013.Patients characteristics, clinical symptoms, medication history, laboratory parameters, radiographic findingsand locations where microorganisms were obtained were recorded.Results 87 patients received 91bronchoscopic exams, including 72 bronchoalveolar lavages,21 bronchial aspirates, and 72 bronchial brushes.The total diagnostic yield was 52. 7% . The diagnostic yield was 71. 4% with bronchoalveolar lavage, 38. 9%with bronchial aspirate, and 18. 1% with bronchial brush. Diagnostic yield was significantly higher in thepatients with clinical symptoms of fever, cough or expectoration compared with the patients without eithersymptoms （ 60. 0% % vs. 34. 6% , P = 0. 028） . The patients with CT finding of nodular, massive orconsolidation had a higher diagnostic yield compared with those with CT findings of reticular, linear or groundglass opacity （ 61. 8% vs. 26. 1% , P = 0. 003 ） . Diagnostic yield was not affected by location ofbronchoalveolar lavage （ P = 0. 691） .Conclusion RAD patients with fever, cough or sputum, and CTfindings of nodular,massive or consolidation would get a higher diagnostic yield by bronchoscopy.

关 键 词：支气管镜 微生物 肺部异常 风湿免疫病 

分 类 号：R593.2[医药卫生—内科学]