摘要
为了确定支气管肺泡灌洗(BAL)和经支气管肺活检(TBLB)对隐源性组织肺炎(COP)的诊断价值,进行了一项前瞻性研究。本研究共纳入37例具有COP临床放射学特征的患者(男性20例,女性17例)。对35例进行统计分析。28名患者被诊断为COP,所有患者都进行了确认性活检。在7个病例中,医生给出了不同的诊断。诊断COP的BAL细胞学和表型标准为:淋巴细胞增多超过25% (CD4/CD8比值小于0.9);结合以下至少两项数据(> 20%的泡沫巨噬细胞,和/或中性粒细胞> 5%,和/或嗜酸性粒细胞> 2%和< 25%)。TBLB标本若表现为:小叶中央空腔内肉芽组织;肺泡壁有慢性炎症细胞浸润;肺泡结构的保存。 BAL was performed in 34 patients; 17 cases were consistent with the final diagnosis of COP (sensitivity 63%), and four cases were correctly classified as negative (specificity 57%). BAL had a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 29%. TBLB was performed in 32 patients; it correctly identified COP in 16 cases (sensitivity 64%), and six cases were correctly classified as negative (specificity 86%). TBLB had a PPV of 94% and a NPV of 40%. The accuracy of the examinations, that is the probability of correctly diagnosing both diseased and nondiseased patients by BAL or TBLB, was 62 and 69%, respectively. Our findings suggest that the combination of cytological bronchoalveolar lavage and histological transbronchial lung biopsy data obtained during a fibreoptic procedure appears to be an effective method for the initial investigation in cryptogenic organizing patients pneumonia presenting with patchy radiographic shadows.