支气管色素沉着纤维化的临床表现、支气管镜改变和CT特征分析  

Analysis of manifestations, bronchoseopy and CT features in bronchial anthracofibrosis

作　　者：孙小丽[1] 朱艳艳[2] 王仁贵[1] 侯代伦[2] 

机构地区：[1]首都医科大学附属北京世纪坛医院放射中心,100038 [2]山东省胸科医院医学影像科

出　　处：《中国防痨杂志》2016年第5期381-385,共5页Chinese Journal of Antituberculosis

基　　金：北京市科技计划课题（Z161100000516075）

摘　　要：目的分析支气管色素沉着纤维化（bronchial anthracofibrosis, BAF）的临床表现、支气管镜和CT检查特征。方法选取2008年2月至2015年5月于首都医科大学附属北京世纪坛医院放射中心经支气管镜检查发现支气管黏膜色素沉积并伴有主支气管或叶段支气管狭窄，确诊为BAF的56例患者作为研究对象。收集其临床资料，分析其支气管镜检查结果、病理结果，以及CT检查结果。结果56例患者，包括男17例（30．4％），女39例（69．6％）；年龄34~87岁（中位年龄57岁）。临床症状主要为咳嗽、咯痰、呼吸困难、咯血等，呈反复慢性病程。支气管镜均显示黏膜色素斑和叶段支气管狭窄或闭塞，其中，单部位受累27例（48．2％），多部位受累29例（51．8%），以右肺中叶支气管狭窄多见。24例行支气管镜下黏膜活检的患者，活检标本病理检查均显示为支气管黏膜的色素沉积，其中13例（56．5％）伴有慢性非特异性炎症，8例（34．8％）表现为伴有干酪样坏死的慢性肉芽肿样炎症，3例（13．oH）为肺癌。CT表现叶段支气管狭窄44例（78．6％），管壁增厚17例（30．4％），纵隔和（或）肺门淋巴结肿大52例（92．9％），伴淋巴结钙化30例（53．6％），肺内表现阻塞性不张38例（67．9％），支气管扩张6例（10．7％），胸膜病变3例（5．4%）。结论BAF好发于老年女性，并与结核病、肺炎、慢性阻塞性肺疾病（chronic obstructive pulmonary diseases，COPD）及恶性肿瘤等相关，主要特征包括支气管黏膜色素沉着、叶段支气管狭窄、气道周围淋巴结增大及多种形态的肺阻塞性或感染性病变。Objective To analyze manifestations, bronchoscopy and CT features in bronchial anthracofibrosis （BAF）. Methods Fifty-six BAF patients diagnosed based on bronchoseopy examination, which showed pigmentation of bronchial mucosa with the main or segmental bronchial stenosis, in Beijing Shijitan Hospital from February 2008 to May 2015 were enrolled in this study. The clinical data were collected, and bronchoseopie, phthologieal, as well as CT results were analyzed. Results Of the 56 patiets, 17 were male （30.4%）, 39 were female （69.6%）, with the range of age from 34 to 87 （median 57）. The main symptoms of this recurrent and chronic disease were cough, expectoration, dyspnea, hemoptysis, etc. And bronchoscopy showed mucosal pigment patch, segmental bronchial stenosis or even occlusion, including single site involvement in 27 cases （48.2 %）, multiple involvement in 29 cases （51.8%）, the right middle lobe bronchus was the most common. Among the 24 patients with pigmentation of bronchial mucosa examined by bronchoscopy biopsy, 13 （56.5%） had chronic nonspecific inflammation, 8 （34.8%） showed chronic granuloma inflammation with caseous necrosis, 3 （13.0 G） were lung cancer. According to CT scan, 44 patiens （78.6%） were found segmental bronchial stenosis, bronchial wall thickening were in 17 （30. 4%）, mediastinal and/or hilar lymph node enlargement were in 52 （92.9%） cases, 30 patiens （53.6%） were with calcified lymph node and 38 （67.9%） were obstructive atelectasis, while bronchiectasis were found in 6 cases （10. 7%） and pleural lesions in 3 cases （5.4%）. Conclusion BAF mostly attacks elderly women and it is correla- ted with tuberculosis, pneumonia, chronic obstructive pulmonary disease （COPD） and malignant tumor. The main features of BAF include pigmentation of bronchial mucosa, segmental bronchial stenosis, airways surrounded by enlarged lymph node and various obstructive or infectious pneumopathy.

关 键 词：色素沉着 纤维化 支气管疾病 支气管镜检查 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤]