Diagnosis of pneumonitis in immunocompromised patients by open lung biopsy
Diagnosis of pneumonitis in immunocompromised patients by open lung biopsy
复制标题
开放性肺活检诊断免疫功能低下患者的肺炎
作者：
MD HARRY W. HAVERKOS;M. A. W. Dowling;ScD Pasculle;MD RICHARD L. MYEROWITZ;MD DAVID 6. LERBERG;MD THOMAS R. HAKALA;J. Dowling;Scaife Hall;PA I526 I. Pitts
本文回顾了59例免疫功能低下的发热和肺浸润性病变患者接受开胸肺活检的临床资料。49例(83%)患者通过肺活检作出特殊诊断，32例(54%)诊断为可治疗的感染。仅有2例(3.4%)假阴性活检。移植受者患特殊的、可治疗的肺炎的可能性(74%)高于网状内皮恶性肿瘤患者(42%，P<；0.05)。这是由于移植受者中细菌性肺炎的频率更高，主要是由于军团菌(P<；0.01)。然而，通过肺活检获得特定的诊断似乎并不能改善结果。32例可治疗感染患者中有17例存活(53%)，相比之下，确诊为特异性但无法治疗的16例患者中有8例存活(50%)，11例非诊断性活检患者中有6例存活(55%)。在移植受者以及白血病和淋巴瘤患者中，高龄和低血小板计数都预示着死亡(P<；0.05)；在肾移植受者中，高血肌酐是另一个预测因素。
The records of 59 immunocompromised patients with fever and pulmonary infiltrates who underwent open lung biopsy, were reviewed. A specific diagnosis was made by lung biopsy in 49 (83%) patients, and in 32 instances (54%) the diagnosis was a treatable infection. Only two (3.4%) false‐negative biopsies occurred. Transplant recipients were more likely to have a specific, treatable pneumonia (74%) than patients with a reticuloendothelial malignancy (42%, P < 0.05). This was due to a greater frequency of bacterial pneumonias, primarily due to Legionella, in transplant recipients (P < 0.01). However, obtaining a specific diagnosis by lung biopsy did not appear to improve outcome. Seventeen of 32 (53%) patients with treatable infections survived, compared to 8 of 16 (50%) with specific, but untreatable, diagnosis and 6 of 11 (55%) with nondiagnostic biopsies. Advanced age and a low platelet count were predictive of death in both transplant recipients and patients with leukemia and lymphoma (P < 0.05); a high serum creatinine was an additional predictor in renal transplant recipients.