Significance of Bronchoalveolar Lavage for the Diagnosis of Idiopathic Pulmonary Fibrosis
Significance of Bronchoalveolar Lavage for the Diagnosis of Idiopathic Pulmonary Fibrosis
复制标题
DOI：
10.1164/rccm.200808-1313oc
复制
发表时间：
2009-06-01
影响因子：
24.7
通讯作者：
Costabel, Ulrich
中科院分区：
文献类型：
--
作者：
Ohshimo, Shinichiro;Bonella, Francesco;Costabel, Ulrich
理论基础：根据2002年ATS/ERS共识分类，没有手术肺活检的特发性肺纤维化(IPF)的诊断具有一致的临床/生理结果和高分辨率计算机断层扫描(HRCT)的典型特征。支气管肺泡灌洗(BAL)和/或经支气管镜活检是2000年ATS/ERS IPF声明中的四个主要标准之一，但在2002年ATS/ERS共识分类的诊断算法中不再是必不可少的。目的：评估BAIL对IPF诊断的附加价值。方法：对101例HRCT疑似IPF的患者进行研究。排除27名患者，原因是缺乏功能损害(n=20)、导致纤维化的潜在疾病(n=5)或与IPF不一致的临床病史(n=2)。其余74名患者符合2002年ATS/ERS共识分类中推荐的所有标准，用于在没有手术活检的情况下做出诊断。对BALL上发现IPF不一致的患者进行进一步的检查，包括病理分析，最终诊断为IPF。测量和主要结果：BALL中淋巴细胞的30%的临界值对IPF的诊断具有良好的鉴别能力。74例患者中有6例(8%)BAL中淋巴细胞增多率达30%或以上。最终诊断为特发性非特异性间质性肺炎(3例)和外源性过敏性肺泡炎(3例)。两例手术活检和4例随后的结果证实了诊断观念的改变。结论：BAL淋巴细胞增多症改变了74例患者中的6例的诊断观念，这些患者本来会被误诊为没有BAL的IPF。
Rationale: According to the 2002 ATS/ERS Consensus Classification, a confident diagnosis of idiopathic pulmonary fibrosis (IPF) without surgical lung biopsy is made with consistent clinical/physiological findings and the typical features on high-resolution computed tomography (HRCT). Bronchoalveolar lavage (BAL) and/or transbronchial biopsy, one of four major criteria in the 2000 ATS/ERS IPF Statement, was no more essential in the diagnostic algorithm of 2002 ATS/ERS Consensus Classification.Objectives: To evaluate the additional utility of BAIL for the diagnosis of IPF.Methods: A total of 101 patients with suspected IPF on HRCT were studied. Twenty-seven patients were excluded because of lack of functional impairment (n = 20), an underlying condition causing fibrosis (n = 5), or a clinical history inconsistent with IPF (n = 2). The remaining 74 patients met all the criteria recommended in the 2002 ATS/ERS Consensus Classification for making a diagnosis in the absence of surgical biopsy. The final diagnosis was made with further examinations, including pathological analysis, in patients who showed inconsistent findings for IPF on BAL.Measurements and Main Results: A cut-off level of 30% for lymphocytes in BAIL demonstrated a favorable discriminative power for the diagnosis of IPF. Six of the 74 patients (8%) showed a lymphocytosis of 30% or greater in BAL. Their final diagnoses were idiopathic nonspecific interstitial pneumonia (n = 3) and extrinsic allergic alveolitis (n = 3). The change in perception of the diagnosis was validated by a surgical biopsy in two cases and by subsequent outcome in four cases.Conclusions: BAL lymphocytosis changed the diagnostic perception in six of 74 patients who would have been misdiagnosed as having IPF without BAL.