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肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)
中华医学会呼吸病学分会
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DOI: 10.3760/cma.j.issn.1001-0939.2017.08.007
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摘要

20世纪60年代后期,可弯曲支气管镜首次应用于临床 [ 1 ] 。1974年Reynolds和Newball [ 2 ] 报道用支气管镜进行支气管肺泡灌洗(broncho alveolar lavage, BAL),为诊断呼吸系统疾病提供了一种新的检查手段。随着临床诊治及检测水平的提高,进一步发现从支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)中可以获取细胞学、可溶性蛋白、酶类、细胞因子、生物活性介质等多种信息,因此BAL成为诊断某些肺部疾病如支气管肺癌、间质性肺疾病、肺部感染性疾病的重要手段 [ 3 , 4 , 5 , 6 , 7 ] 。为规范BAL的操作技术,中华医学会呼吸病学分会根据我国具体情况于2002年制定了"支气管肺泡灌洗液细胞学检查技术规范(草案)" [ 8 ] 。美国胸科医师学会2012年颁布了"支气管肺泡灌洗液的细胞学分析在间质性肺疾病中的临床应用" [ 9 ] 。近年来,BALF中半乳甘露聚糖(galactomannan,GM)试验作为非培养性检测手段诊断侵袭性肺曲霉病,因其良好的敏感度和特异度,成为美国感染病学会(IDSA)和欧洲癌症研究和治疗侵袭性真菌感染协作组及美国变态反应和感染性疾病协会真菌病研究组(EORTC/MSG)推荐的诊断标准之一 [ 10 , 11 ] 。目前国内外应用BALF检测病原体的具体操作及处理流程不同。为了更充分利用BALF的检测价值、增加BALF病原体的检出率、提高肺部感染性疾病的诊治成功率,需要进一步规范BAL的操作流程及标本处理,以便更好地指导临床。为此,中华医学会呼吸病学分会感染学组组织专家撰写了"肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识"。

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中华医学会呼吸病学分会. 肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)[J]. 中华结核和呼吸杂志,2017,40(8):578-583.

DOI:10.3760/cma.j.issn.1001-0939.2017.08.007

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20世纪60年代后期,可弯曲支气管镜首次应用于临床 [ 1 ]。1974年Reynolds和Newball [ 2 ]报道用支气管镜进行支气管肺泡灌洗(broncho alveolar lavage, BAL),为诊断呼吸系统疾病提供了一种新的检查手段。随着临床诊治及检测水平的提高,进一步发现从支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)中可以获取细胞学、可溶性蛋白、酶类、细胞因子、生物活性介质等多种信息,因此BAL成为诊断某些肺部疾病如支气管肺癌、间质性肺疾病、肺部感染性疾病的重要手段 [ 3 , 4 , 5 , 6 , 7 ]。为规范BAL的操作技术,中华医学会呼吸病学分会根据我国具体情况于2002年制定了"支气管肺泡灌洗液细胞学检查技术规范(草案)" [ 8 ]。美国胸科医师学会2012年颁布了"支气管肺泡灌洗液的细胞学分析在间质性肺疾病中的临床应用" [ 9 ]。近年来,BALF中半乳甘露聚糖(galactomannan,GM)试验作为非培养性检测手段诊断侵袭性肺曲霉病,因其良好的敏感度和特异度,成为美国感染病学会(IDSA)和欧洲癌症研究和治疗侵袭性真菌感染协作组及美国变态反应和感染性疾病协会真菌病研究组(EORTC/MSG)推荐的诊断标准之一 [ 10 , 11 ]。目前国内外应用BALF检测病原体的具体操作及处理流程不同。为了更充分利用BALF的检测价值、增加BALF病原体的检出率、提高肺部感染性疾病的诊治成功率,需要进一步规范BAL的操作流程及标本处理,以便更好地指导临床。为此,中华医学会呼吸病学分会感染学组组织专家撰写了"肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识"。
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备注信息
A
瞿介明,200025上海交通大学医学院附属瑞金医院呼吸与危重症医学科,Email: mocdef.3ab616090uqmj;周建英,310003浙江大学医学院附属第一医院呼吸科,Email: mocdef.3ab61yjzrd;俞云松,310000浙江大学医学院附属邵逸夫医院感染科,Email: mocdef.3ab61911syvy
B
国家重点研发计划"重大慢性非传染性疾病防控研究" (2017YFC1309704)
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