17例特发性间质性肺炎临床病理分析及纤维化程度评估  

Clinic pathologic analysis and evaluation of fibrosis in 17 cases of idiopathic interstitial pneumonia

作　　者：李阳[1] 熊焰[1] 李挺[1] 

机构地区：[1]北京大学第一医院病理科,北京100034

出　　处：《北京大学学报（医学版）》2010年第5期520-525,共6页Journal of Peking University:Health Sciences

摘　　要：目的:探讨特发性间质性肺炎(idiopathic interstitial pneumonia,IIP)的诊断原则和组织病理诊断价值,以及纤维化程度的客观定量评估指标。方法:选取2004～2009年间具有相对完整的临床、影像学和病理资料的17例IIP,参照国际最新分类标准进行组织学分析及纤维化程度分级评估,并采用免疫组织化学方法对肺间隔纤维化病灶CD34和SMA染色进行半定量评估,分析两者表达变化与纤维化程度的相关性。结果:17例IIP组织学改变结合临床、影像学特征可诊断为普通型间质性肺炎9例、隐源性机化性肺炎5例及非特异性间质性肺炎3例;SMA表达与肺间隔纤维化程度呈正相关性(r=0.928,P=0.01),而CD34呈负相关性(r=-0.606,P=0.01)。结论:病理组织学在IIP诊断及分类中有重要意义,多数病例组织学改变结合临床和影像学可对IIP及其类型做出明确诊断;规范适量的活检取材是正确诊断的重要前提;SMA和CD34表达可用于IIP常规纤维化程度病理学评估。Objective：To explore the general principles and the significance of histopathology for idiopathic interstitial pneumonia （IIP） diagnosis;and to investigate the quantitative parameters in evaluation of fibrosis degree of IIP.Methods：17 cases of IIP were collected from Peking University 1st Hospital between 2004 and 2009,which had relatively integrated clinical,radiological and pathological materials.Combining clinical and radiological characteristics,histological manifestations and fibrosis degree were analyzed according to American Thoracic Society/European Respiratory Society （ATS/ERS） international consensus classification.Immunohistochemical staining for CD34 and SMA were performed and the correlation between their expressive extent and fibrosis degree were analyzed.Results：17 cases of IIP were diagnosed by clinical-radiological-pathological comprehensive analysis,which included 9 cases of usual interstitial pneumonia,5 cases of cryptogenic organizing pneumonia and 3 cases of nonspecific interstitial pneumonia;SMA expression showed positive correlation with degree of fibrosis（r=0.928,P=0.01）,and CD34 expression showed negative correlation with degree of fibrosis（r=-0.606,P=0.01）.Conclusion：Histopathology plays an important role in the diagnosis and classification of IIP.By combining histopathologic pattern,clinical and radiological features,a definite type of IIP can be confirmed.Proper and sufficient biopsy specimens are the premise of right diagnosis.CD34 and SMA immunohistochemical staining can be used in routine practice to evaluate the fibrosis degree of IIP.

关 键 词：肺疾病 间质性 纤维化 抗原 CD34 平滑肌肌动蛋白 病理学 临床 

分 类 号：R563.13[医药卫生—呼吸系统]