职业相关性肺病中的病理特征及肺活检在其诊断中的意义  

Pathological features and diagnostic significance of lung biopsy in occupational lung diseases

作　　者：王婷[1] 付尧[1] 马苗[2] 周晋 孙琦[1] 冯安宁[1] 孟凡青[1] Wang Ting;Fu Yao;Ma Miao;Zhou Jin;Sun Qi;Feng Anning;Meng Fanqing(Department of Pathology,Nanjing Drum Tower Hospital/the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Respiratory Medicine,Nanjing Drum Tower Hospital/the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Medical Imaging,Nanjing Drum Tower Hospital/the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院病理科,南京210008 [2]南京大学医学院附属鼓楼医院呼吸内科,南京210008 [3]南京大学医学院附属鼓楼医院影像科,南京210008

出　　处：《中华病理学杂志》2023年第11期1114-1119,共6页Chinese Journal of Pathology

摘　　要：目的探讨职业相关性肺病的临床病理形态学特征,为临床诊断及鉴别诊断提供有效补充,以减少该类病变的漏诊与误诊,保障患者的规范化诊治。方法回顾性分析南京大学医学院附属鼓楼医院病理科2017—2019年肺活检病理组织标本共4813例(包含会诊病例1935例),其中经临床-影像-病理学诊断确诊职业相关性肺病126例,结合特殊染色、结核PCR检测与扫描电子显微镜平台结果进行鉴别诊断。结果经临床-影像-病理学确诊为职业相关性肺病患者126例,其中男性102例,女性24例,均追溯到职业有害因素暴露史。形态学方面:68.3%(86/126)主要表现为肺纤维化结节、尘斑形成或肺实质炭沫沉着;16.7%(21/126)主要表现为肺泡腔及肺间质内电焊烟尘颗粒沉积;15.1%(19/126)表现为肉芽肿伴纤维组织增生、肺泡蛋白沉积或巨细胞间质性肺炎。通过扫描电子显微镜平台对肺组织残留粉尘成分进行定性和半定量分析对于焊工尘肺病与硬金属肺病的诊断有帮助。结论肺活检组织的形态学特征性改变是职业相关性肺病临床病理诊断和鉴别诊断的重要参考依据,病理医师对该病形态学及辅助检查的认知程度是肺活检标本发挥其诊断职业相关性肺病价值的关键所在。Objective To investigate the clinicopathological characteristics of occupational lung diseases,to reduce the missed diagnoses and misdiagnoses of the diseases and to help standardize the diagnosis and treatment of these patients.Methods A total of 4813 lung biopsy specimens(including 1935 consultation cases)collected at the Department of Pathology,Nanjing Drum Tower Hospital,Nanjing,China from January 1st,2017 to December 31th,2019 were retrospectively analyzed.Among them,126 cases of occupational lung diseases were confirmed with clinical-radiological-pathological diagnosis.Special staining,PCR and scanning electron microscopy were also used to rule out the major differential diagnoses.Results The 126 patients with occupational lung diseases included 102 males and 24 females.All of them had a history of exposure to occupational risk factor(s).Morphologically,68.3%(86/126)of the cases mainly showed pulmonary fibrotic nodules,dust plaque formation or carbon end deposition in pulmonary parenchyma.16.7%(21/126)of the cases mainly showed welding smoke particle deposition in the alveolar cavity and lung interstitium while 15.1%(19/126)of the cases showed granulomas with fibrous tissue hyperplasia,alveolar protein deposition or giant cell interstitial pneumonia.The qualitative and semi-quantitative analyses of residual dust components in the lung under scanning electron microscope were helpful for the diagnosis of welder′s pneumoconiosis and hard metal lung disease.Conclusions The morphological characteristics of lung biopsy tissue are important reference basis for the clinicopathological diagnosis and differential diagnosis of occupational lung diseases.Recognizing the characteristic morphology and proper use of auxiliary examination are the key to an accurate diagnosis of occupational lung diseases on biopsy specimens.

关 键 词：肺疾病 职业病 活组织检查 诊断 鉴别 

分 类 号：R135[医药卫生—劳动卫生]