经支气管镜肺活检对弥漫性肺实质疾病的诊断价值

The diagnostic value of transbronchial lung biopsy in diffuse parenchymal lung diseases

目的评价经支气管镜肺活检（TBLB）在弥漫性肺实质病变诊断中的作用。方法回顾性分析2001年1月至2006年10月在北京协和医院住院、经TBLB检查且具有完整临床资料的肺部弥漫性疾病患者416例，男157例，女259例，平均年龄（42.6±18.9）岁。结果416例中124例（29.8％）经支气管镜肺活检确诊，其中结节病52例（41.9％），闭塞型细支气管炎伴机化性肺炎（BOOP/OP）28例（22.6％），肺泡蛋白沉积症（PAP）19例（15.3％），肺部肿瘤12例（9.7％），肺血管炎5例（4.0％），肺结核3例（2.4％），肺孢子菌肺炎、曲霉肺炎、嗜酸细胞肺炎、淋巴管肌瘤病（LAM）及肺淀粉样变各1例。经支气管镜肺活检未确定诊断的患者中104例进行了开胸或胸腔镜活检，98例确诊，其中非特异性间质性肺炎37例（37.7％），寻常型间质性肺炎18例（18.4％），结节病11例（11.2％），BOOP／OP6例（6.1％），肿瘤5例（5.1％），外源性过敏性肺泡炎4例（4.1％），曲霉肺炎、PAP、淋巴细胞间质性肺炎、肺动脉高压及LAM各2例（各占2.0％），结核、肺血管炎、组织细胞增生症X、呼吸细支气管炎伴问质性肺炎、脱屑性问质性肺炎、弥漫性泛细支气管炎、气道中心性纤维化各1例（各占1.0％）。结论TBLB可对约30％的肺部弥漫性肺疾病确诊，可作为开胸之前的常规筛查手段。

Objective This study was to evaluate the efficacy and limitations of transbronchial lung biopsy （TBLB） in the diagnosis of diffuse parenchymal lung diseases （DPLD）. Methods TBLB was performed in 416 patients with diffuse lung diseases from January 2001 to October 2006 in Peking Union Medical College Hospital. The results of clinical data and pathologic diagnosis were retrospectively analyzed. Results Confirmed diagnosis by TBLB was obtained in 124 patients, the total positive diagnostic rate was 29. 8%. The diseases included pulmonary sarcoidosis （52/124,41.9%）, bronchiolitis obliterans organizing pneumonia/organizing pneumonia （BOOP/OP） （28/124,22. 6% ）, pulmonary alveolar proteinosis （ 19/ 124, 15. 3% ）, lung cancer （ 12/124, 9. 7% ）, pulmonary vasculitis （ 5/124, 4. 0% ）, pulmonary tuberculosis （ 3/124, 2. 4% ）, and pneumocystis carinii pneumonia, lung fungal infection, lymphangiomyomatosis, and pulmonary amyloidosis （each 1/124, 0. 8% ）. Open lung or thoracoscopic biopsy was performed in 104 cases in whom the diagnosis was undetermined by TBLB. Confirmed diagnosis was obtained in 109 patients, including nonspecific interstitial pneumonia （37/104, 37.7% ）, usual interstitial pneumonia （ 18/104, 18.4% ）, pulmonary sarcoidosis （ 11/104, 11.2% ）, BOOP/OP （6/104, 6. 1% ）, and lung cancer （5/104, 5. 1% ）. Conclusions Pathologic diagnosis can be obtained by TBLB in about 30% of the cases with DPLD, and therefore it should be considered to be a routine diagnostic procedure before open lung or thoracoscopic biopsy.