经支气管镜肺活检在特发性间质性肺炎中的诊断价值  

The Effectiveness of Transbronchial Lung Biopsy in the Diagnosis of Idiopathic Interstitial Pneumonia

作　　者：兰学立[1] 李海潮[1] 熊焰[2] 阙呈立[1] 聂立功[1] 柳平[2] 王仁贵[3] 何冰[1] 

机构地区：[1]北京大学第一医院呼吸内科,北京100034 [2]北京大学第一医院病理科,北京100034 [3]北京大学第一医院影像科,北京100034

出　　处：《中国呼吸与危重监护杂志》2013年第1期69-74,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的评价经支气管镜肺活检(TBLB)病理在特发性间质性肺炎(IIP)诊断及预后评价中的作用。方法回顾性分析2005年1月至2009年4月在北京大学第一医院住院治疗的29例IIP患者的相关临床资料,联合病理科医师对相应的TBLB标本病理进行重新判读和分析并做出病理诊断,重新阅读患者的胸部HRCT,并对患者进行随访。分析影响TBLB诊断价值的因素,观察TBLB病理表现与预后的关系。结果在29例IIP患者中,男21例,女8例;年龄43～79岁,平均(63±10)岁。获取具有诊断价值TBLB标本16例,肺组织块2～7块,平均(4.2±1.8)块;不具有诊断价值13例,肺组织块0～5块,平均(2.1±1.6)块,与有诊断价值标本的肺组织块数量差异有统计学意义(P<0.005)。具有诊断价值标本中,TBLB表现为非特异性间质性肺炎(NSIP)9例、寻常性间质性肺炎(UIP)6例、机化性肺炎(OP)1例。29例患者中,HRCT表现为UIP样改变14例,获取具有诊断价值TBLB标本5例(35.7%);HRCT表现为non-UIP样改变15例,获取具有诊断价值TBLB标本11例(73.3%)。16例随访结果显示,TBLB表现为UIP 6例,死亡5例,加重1例;NSIP 9例,缓解8例,死亡1例;OP 1例,症状缓解。TBLB表现为non-UIP组生存时间明显长于UIP组(P<0.005)。结论TBLB的诊断价值与获取肺组织块数量及HRCT表现密切相关。肺组织块数量≥3块时,TBLB具有较高的诊断价值。与HRCT表现UIP者相比,表现为non-UIP者更易获得有诊断价值的TBLB标本。TBLB表现为non-UIP改变者预后好于UIP。TBLB有助于IIP的诊断及预后评价。Objective To investigate the role of transbronchial lung biopsy （TBLB） in the diagnosis and prognosis evaluation of idiopathic interstitial pneumonia （IIP）. Methods Clinical data of IIP patients admitted to Peking University First Hospital from January 2005 to April 2009 were analyzed retrospectively, The pathologic manifestations of TBLB samples of these patients had been reviewed by pathologists and respirologists. Chest high-resolution computer tomography （HRCT） of the patients had been reviewed, and subsequent follow-ups were performed. The influence factors on diagnosis value of TBLB were analyzed. The relationship between TBLB findings and prognosis were observed. Results 29 IIP patients had been investigated ,among them 21 were male and 8 were female,ranging in age from 43 to 79 years ,with an average of 63 a= 10 years. 16 TBLB samples bad diagnostic value, among them the total number of the samples was from 2 to 7 ,with an average of 4. 2 ＋ 1.8. 13 TBLB samples had no diagnostic value, among them the total number of the samples was from 0 to 5, with an average of 2. 1 ~ 1.6. There was significant differences between two groups （P 〈 0. 005 ）. Among the 16 cases with diagnostic value of TBLB, non-specific interstitial pneumonia （NSIP） pattern was showed in 9 cases, usual interstitial pneumonia （UIP） pattern in 6 cases and organizing pneumonia （OP） in 1 case. Among 29 cases, UIP-like pattern was showed on HRCT in 14 eases,while non-UIP pattern showed on HRCT in 15 cases. On follow-up of the 16 patients, l patient aggravated and 5 patients died among 6 cases with UIP pattern,8 patients got better and 1 patient died among 9 cases with NSIP pattern, and the patient with OP got better. The patients who show non-UIP pattern in TBLB survived longer than UIP pattern with significant difference between two groups （ P 〈 0. 005 ）. Conclusions The diagnosis value of TBLB is strongly related to the number of samples and the patterns of HRCT. When the number of samples is more than o

关 键 词：经气管镜肺活检 特发性间质性肺炎 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]