不同活检方式在特发性间质性肺炎中的诊断意义  

The Effectiveness of Different Biopsy Methods in Diagnosis of Idiopathic Interstitial Pneumonia

作　　者：韩茜[1] 罗群[1] 吴璐璐[1] 廖理粤[1] 周滢[1] 陈荣昌[1] 

机构地区：[1]广州医科大学附属第一医院广州呼吸疾病研究所呼吸内科,广东广州510120

出　　处：《中国呼吸与危重监护杂志》2015年第1期64-67,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家青年科学基金(编号:81300063)

摘　　要：目的评价经支气管镜肺活检(TBLB)及外科肺活检(SLB)在特发性间质性肺炎(IIP)诊断中的价值。方法回顾性分析2010年1月至2013年12月在广州医科大学附属第一医院呼吸内科住院诊断为IIP的患者。将患者按照不同初始诊断进行分类,并统计各组患者实施有创检查情况及出院诊断。结果经本院呼吸内科最终诊断为IIP的患者共391例,平均年龄为(62.5±11.9)岁。未行有创检查患者49例,行TBLB检查患者299例,行SLB检查患者43例。299例实施TBLB检查的患者中,132例(44.1%)未取到肺组织,167例(55.9%)成功获取肺组织,其中具有诊断价值者79例(47.3%)。依靠TBLB检查结果最终诊断为非特异性间质性肺炎(NSIP)30例,隐源性机化性肺炎(COP)22例,特发性肺纤维化(IPF)18例,急性间质性肺炎(AIP)4例,呼吸性细支气管炎相关性间质性肺疾病(RB-ILD)与淋巴细胞性间质性肺炎(LIP)各2例,脱屑性间质性肺炎(DIP)1例。43例实施SLB检查的患者中,所有患者均成功获取肺组织,其中具有诊断价值者40例(93.0%)。依靠SLB检查结果最终诊断为NSIP 20例,IPF 12例,COP与LIP各3例,RB-ILD与DIP各2例。在181例未实施有创性检查或未能成功通过有创性检查获取肺组织的患者中,40例患者可通过临床资料获得最终诊断,最终诊断均为IPF。结论病理诊断在IIP诊断中发挥重要作用,TBLB或SLB均可为IIP的病理诊断提供依据。具体的活检方式可根据当地医院及患者本身的情况进行选择。Objective To evaluate the effectiveness of different biopsy methods in the diagnosis of idiopathic interstitial pneumonia( IIP). Methods A retrospective analysis was performed in patients hospitalized and diagnosed as IIP between January 2010 to December 2013 in the Department of Respiratory Medicine,the First Affiliated Hospital of Guangzhou Medical University. The patients were divided based on initial diagnoses. The performance of invasive examinations including both transbronchoscopic lung biopsy( TBLB) and surgical lung biopsy( SLB) and final diagnoses were recorded. Results Three hundred and ninety-one patients were included in the study with mean age of 62. 5 ± 11. 9 years. There were 299 patients receiving TBLB,43 patients receiving SLB,and 49 patients receiving non-invasive examinations. Among 299 patients who underwent TBLB,parenchymal tissue was not obtained in 132( 44. 1%) but successfully obtained in 167( 55. 9%) patients,with 79( 47. 3% out of 167) clinically helpful. TBLB-based specific diagnoses were as follows: 30 cases of non-specific interstitial pneumonia( NSIP),22 cases of cryptogenic organizing pneumonia( COP),18 cases of idiopathic pulmonary fibrosis( IPF),4 cases of acute interstitial pneumonia( AIP),2 cases of respiratory bronchiolitis-interstitial lung disease( RB-ILD) and lymphocytic interstitial pneumonia( LIP) for each,1 case of desquamative interstitial pneumonia( DIP),respectively.Among 43 patients who underwent SLB,parenchymal tissue was obtained in all cases with 40( 93. 0% out of43) pathologically diagnostic,including 20 cases of NSIP,12 cases of IPF,3 cases of COP and LIP for each,and 2 cases of RB-ILD and DIP for each. Finally,among 181 patients who failed to obtain parenchymal tissue or did not undergo invasive examination,specific diagnoses could be established in 40 patients with all finally diagnosed as IPF. Conclusions The pathological diagnosis,either based on TBLB or SLB,is very important in the diagnostic procedure of IIP. The biopsy technique of hospital and patient c

关 键 词：经支气管镜肺活检 外科肺活检 特发性间质性肺炎 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]