ASSESSMENT OF THE UTILITY OF REPEAT FIBEROPTIC BRONCHOSCOPY IN DIAGNOSIS

免疫功能低下(IC)患者的反复肺部症状是一种 常见问题，它们构成了诊断和治疗方面的挑战。 经常进行重复FOB，因为它相对安全，而且更具侵入性 手术可能是有风险的，也可能是相反的。这项研究的目的 目的是评价重复FOB的诊断和治疗效果。 IC患者。对所有IC进行回溯性图表审查 1987年1月1日至2011年6月在我科接受重复离岸价手术的患者 6/3092。患者被归类为患有“持续性”肺病 疾病(DZ)(如文件所示，重复FOB在3天内完成) 初始FOB)，或“新”DZ(如文件所示，并执行所有重复FOB 自最初离岸价格起计30天后)。在感染艾滋病毒的患者中， 3/15重复FOB(20%)伴新DZ和3/25发现新诊断 (12%)持续DZ(p=NS)；7/15开始改变治疗 对新的DZ重复FOB(47%)，对永久性DZ(p=NS)重复8/25(32%)。 在血液/肿瘤学疾病中，6/10发现了新的诊断。 对新的DZ重复FOB(60%)，对永久DZ重复7/32(22%) (P=0.03)；治疗的改变始于7/10重复FOB(70%)， 新的DZ和13/32(41%的持久性DZ)(p=.11)。在患有 在其他免疫功能受损的情况下，1/9发现了新的诊断 对新的DZ重复FOB(11%)，对持久DZ(p=NS)重复4/12(33%)；a 在使用新的DZ的3/9重复FOB(33%)中开始治疗改变，并且 10/12(83%)合并持续性DZ(p=0.02)。总而言之，诊断 在HIV感染患者中，重复FOB的收益率对 新的或持续的DZ的存在；在患有 血液/肿瘤疾病和新的DZ，重复FOB更有可能 建立新的诊断；并在其他免疫功能低下的患者中 有条件时，重复FOB可用于指导治疗。

Recurrent pulmonary symptoms in immunocompromised (IC) patients are a common problem, and they pose diagnostic and therapeutic challenges. Repeat FOB is often performed as it is relatively safe, and more invasive procedures may be risky or contra-indicated. The purpose of this study was to evaluate the diagnostic and therapeutic efficacies of repeat FOB in IC patients. A retrospective chart review was performed for all IC patients undergoing repeat FOB in our department from 1/1/87 through 6/3092. Patients were classified as having either "persistent" pulmonary disease (dz) (as documented, and with repeat FOB performed within 3) days of initial FOB), or "new" dz (as documented, and all repeat FOB performed after 30 days from the initial FOB). In patients with HIV infection, a new diagnosis was found in 3/15 repeat FOB (20%) with new dz and 3/25 (12%) with persistent dz (p=NS); change in therapy was initiated in 7/15 repeat FOB (47%) with new dz, and 8/25 (32%) with persistent dz (p=NS). In hematologic/oncologic disorders, a new diagnosis was found in 6/10 repeat FOB (60%) with new dz, and in 7/32 (22%) with persistent dz (p=0.03); a change in therapy was initiated in 7/10 repeat FOB (70%) with new dz, and in 13/32 (41% with persistent dz (p=.11). In patients with other immunocompromised conditions, a new diagnosis was found in 1/9 repeat FOB (11%) with new dz, and 4/12 (33%) with persistent dz (p=NS); a change in therapy was initiated in 3/9 repeat FOB (33%) with new dz, and in 10/12 (83%) with persistent dz (p=0.02). In conclusion, the diagnostic yield to repeat FOB in patients with HIV infection is equally effective in the presence of new or persistent dz; in patients with hematologic/oncologic disorders and new dz, repeat FOB is more likely to establish a new diagnosis; and in patients with other immunocompromised conditions, repeat FOB may be useful in guiding therapy.