文摘
为了确定支气管肺泡灌洗(BAL)的诊断价值和transbronchial肺活检(TBLB)在不明原因引起的组织肺炎(COP)进行了前瞻性研究。连续三十7患者(男性和女性17日)20日clinicoradiological警察进入研究的特点。统计分析在35例完成。二十八患者诊断有警察,他们确认活检。在七个国家,一个不同的诊断。BAL细胞学和显性标准考虑警察的诊断是:超过25%的淋巴球增多(CD4 / CD8比值小于0.9);结合以下数据的至少两个(泡沫状巨噬细胞> 20%,和/或中性粒细胞> 5%,和/或嗜酸性粒细胞>和< 25%)2%。TBLB标本分为积极的警察如果他们显示:芽内肉芽组织的小叶中心的空气空间;肺泡壁的慢性炎性细胞浸润;和保护肺泡结构。 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.