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目的肺部感染在风湿免疫病患者中常见,支气管镜下检查有助于更好获取微生物,但支气管镜检查存在风险。通过对风湿免疫病合并肺部异常患者中支气管镜下获取微生物的影响因素进行研究,以期提高检查阳性率。方法回顾性分析2009年1月至2013年6月期间北京协和医院风湿免疫科收治的风湿免疫病合并肺部异常并行支气管镜检查以获取微生物的患者。采集患者特征、临床症状、用药史、实验室检查、影像表现和检查所在肺叶等资料。结果共87例患者接受91例次支气管镜检查,包括72例肺泡灌洗,21例支气管吸取和72例毛刷,总阳性率为52.7%,支气管吸取物的阳性率为71.4%,肺泡灌洗液的阳性率为38.9%,毛刷阳性率为18.1%。伴有发热、咳嗽或咳痰等临床症状的风湿免疫病患者较无此症状的患者微生物检查阳性率更高(60.0%%比34.6%,P=0.028);胸部CT表现为结节、团块或实变的患者较表现为网格、索条或磨玻璃影的患者具有更高的阳性率(61.8%比26.1%,P=0.003)。灌洗部位对诊断阳性率无显著影响(P=0.691)。结论伴有发热、咳嗽或咳痰等临床症状以及胸部CT表现为结节、团块或实变的风湿免疫病患者支气管镜下获取微生物的阳性率更高。
Aims Pulmonary infections are common in patients with rheumatoid immunity and bronchoscopy contributes to better access to microorganisms, but there is a risk of bronchoscopy. Through rheumatoid immune disease associated with lung abnormalities in patients with bronchoscopic microbiological factors to study to improve the positive rate of examination. Methods A retrospective analysis of patients with rheumatoid arthritis admitted to the Rheumatology Department of Peking Union Medical College Hospital from January 2009 to June 2013 with bronchoscopic abnormal lung biopsy to obtain micro-organisms was performed. Patient characteristics were collected, clinical symptoms, medication history, laboratory tests, imaging performance and examination of lung lobes and other information. Results A total of 87 patients underwent bronchoscopy, including 72 cases of bronchoalveolar lavage, 21 cases of bronchial aspiration and 72 cases of brush. The total positive rate was 52.7%. The positive rate of bronchial aspirate was 71.4% The positive rate of liquid was 38.9%, the positive rate of brush was 18.1%. Patients with rheumatic immunity who had clinical symptoms such as fever, cough or sputum had a higher positive rate of microbiological examination (60.0% vs 34.6%, P = 0.028) than those without this symptom. The chest CT showed nodules, clumps Or consolidation patients had a higher positive rate (61.8% vs. 26.1%, P = 0.003) than patients presenting with gridding, ribbons, or ground glassography. Lavage site had no significant effect on the diagnostic positive rate (P = 0.691). Conclusions The positive rate of bronchoscopy for acquiring microbes is higher in patients with rheumatic immunity accompanied by clinical symptoms such as fever, cough or sputum as well as those with chest CT showing nodules, mass or consolidation.