73例活检证实的肺部肉芽肿性病变的诊断分析

Diagnosis analysis of 73 patients proven to be pulmonary granuloma by biopsy

目的经活检证实为肺部肉芽肿性病变的部分病例诊断存在一定困难。本研究欲对活检证实的肺部肉芽肿性病变的诊断思路进行分析，查找其中的规律。方法收集2005年2月至2007年1月73例病例，均活检经病理证实为肺部肉芽肿性病变，分析其最终诊断构成、临床症状、影像学、病理学及特殊诊断性试验的阳性率。结果73例患者中感染性疾病占据多数，为40例，占54．8％。感染性疾病中病原体以真菌为主，占80％。结节病占38．4％。临床特征特异性不明显，46．6％的肺新隐球菌病和42．9％的结节病患者无自觉症状。曲霉菌感染高分辨率CT可见“空气新月征”及“晕轮征”等改变，有一定特异性。病理HE染色联合病理特殊染色对肉芽肿性病变的鉴别诊断有重要提示作用。真菌新型抗原检测包括血清半乳甘露聚糖抗原检测和血清新隐球菌乳胶凝集试验是明确真菌感染的重要辅助检测手段。结论肺部肉芽肿性病变最终确诊需综合考虑，临床微生物的检测、血清真菌新型抗原检测、病理及其特殊染色等综合评价对肺部肉芽肿性病变的鉴别诊断意义较大。

Objective It is difficult to clarify the final diagnosis of patients who are proved to be with pulmonary granuloma by biopsy. This study ought to search the pattern of diagnosis means by analyzing the patients with pulmonary granuloma. Methods Seventy-three patients who were proved to be with pulmonary granuloma by biopsy were collected. The following items were observed：constituent ratios of final diagnosis, clinical features, radiology, lung pathology and special stain, sensitivity and specificity of serum diagnostic test. Results Patients with pulmonary infectious diseases accounted for 54.8% （40/73） of all the cases. Fugal infection was the common factor, accounted for 80% of infectious diseases. Sarcoidosis accounted for 38.4%. There was little specificity to clarify the diagnosis by clinical features. 46.6% of Cryptococcus neoformans and 42.9% of sarcoidosis patients had no subjective symptom. Air crescent and halo sign in high resolution CT were special for pulmonary aspergillus infection. Hematoxylin and eosin stain and special stain with lung tissues were very important to clarify the diagnosis. Fungal antigens such as galactomannan and latex agglutination test had high sensitivity and specificity for diagnosing fungal infections. Conclusions The final diagnosis is a colligation of all factors. Integrated the clinical microorganism detection, serum fungal antigens, lungs pathology and their special stains are important for clarifying diagnosis.