支气管镜检查对肺结节病的诊断价值  

The value of bronchoscopy in the diagnosis of sarcoidosis

作　　者：佟冰[1] 徐燕[1] 钟巍[1] 赵静[1] 陈闽江[1] 邵池[1] 孙雪峰[1] 钟旭[1] 王孟昭[1] 

机构地区：[1]中国医学科学院北京协和医院呼吸内科,100730

出　　处：《中华结核和呼吸杂志》2015年第11期839-843,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 评价支气管镜检查对肺结节病的诊断价值.方法 回顾性分析2009年6月至2014年6月在北京协和医院门诊就诊并经支气管镜检查的200例结节病患者的临床资料,其中男61例,女139例,年龄18 ～69岁,平均（48±10）岁.根据患者支气管镜下表现分组,以多发结节或寡结节为主要改变的患者归为典型黏膜改变组（125例）,其余归为非典型黏膜改变组（75例）,分析支气管镜下表现和各种活检方法的诊断价值.结果 200例中145例（72.5％）经支气管镜下不同方式取材活检确诊,15例（7.5％）经纵隔镜淋巴结活检、经皮肺穿刺、皮肤活检或浅表淋巴结活检确诊,40例（20％）无典型病理学证据但长期随诊观察糖皮质激素治疗有效或病情自发缓解后临床诊断结节病.支气管黏膜活检（EBB）、经支气管肺活检（TBLB）及经支气管超声内镜引导针吸活检（EBUS-TBNA）的病理阳性率分别为71.1％ （106/149）、46.8％（29/62）和46.8％（22/47）,三者比较差异有统计学意义（x2 =35.508,P＜0.001）.典型黏膜改变组EBB检查的活检阳性率为80.8％（101/125）,EBB联合TBLB和（或）EBUS-TBNA的活检阳性率为83.3％（105/125）,差异无统计学意义（x2 =0.441,P＞0.05）.无典型黏膜改变组的患者EBB病理阳性者仅5例,联合TBLB和TBNA检查,阳性者提高到12例,差异有统计学意义（x2=4.463,P＜0.05）.结论 对于典型支气管黏膜病变显著的结节病患者,EBB检查安全简便、阳性率高,为首选取材途径;对于无典型黏膜改变组的患者,联合TBLB、TBNA和BALF检查可提高活检阳性率.Objective To evaluate the role of bronchoscopy in the diagnosis of sarcoidosis.Methods A retrospective analysis was conducted for 200 patients who were diagnosed to have sarcoidosis and underwent bronchoscopy from June 2009 to June 2014 in Peking Union Medical College Hospital.The diagnostic value of different bronchoscopic procedures was analyzed.Results Of the 200 patients,145 were finally confirmed to have sarcoidosis by pathology through bronchoscopic sampling techniques.The diagnostic yields of endobronchial biopsy （EBB）,transbronchial lung biopsy （TBLB）,and EBUS-TBNA were 71.14%,46.77%,46.80%,respectively.The yields among the 3 techniques were statistically different.In those with mucosal lesions,the yield of EBB was 80.80%,while that of the combination of EBB,TBLB and EBUS-TBNA was 83.3%,the difference being not significant.In those without mucosal lesions,the yields of EBB,and the combination of EBB,TBLB and EBUS-TBNA were 20.8% and 48.0% respectively,with significant difference（x2 =4.463,P =0.035）.Conclusions EBB is a preferred approach for the diagnosis of sarcoidosis with endobronchial abnormalities,while for cases without mucosal lesions,combined TBLB,EBUS-TBNA and bronchoalveolar lavage can improve the diagnostic yield.

关 键 词：支气管镜检查 结节病 诊断 

分 类 号：R563[医药卫生—呼吸系统]