纤维支气管镜肺活检在尘肺诊断中的价值

The usefulness of lung biopsy by fiber bronchoscopy in diagnosis of pneumoconiosis

目的探讨经纤维支气管镜肺活检在尘肺诊断中的价值。方法对2008年1月至2010年6月有粉尘接触者共171例接受纤维支气管镜肺活检(TBLB)、支气管肺泡灌洗(BAL)、支气管刷检,对细菌学、细胞学及病理学检查结果,并结合职业卫生、临床、影像学检查等进行了回顾性分析。结果本组171例受检者中169例获得了合格肺组织标本,其中166例有肺间质纤维化改变(139例检查出成纤维细胞增生,99例胶原纤维形成),120例有粉尘沉着,40例偏光镜检查阳性,48例普鲁士蓝铁染色阳性。结合职业健康监护、临床、影像学等资料综合分析后,对照尘肺病诊断标准片确诊各类职业性尘肺病162例,无尘肺7例。结论经纤维支气管镜肺活检在尘肺病的诊断及鉴别诊断中有较高的应用价值。

Objective To explore the diagnostic value of lung biopsy by fiber bronchoscopy in pneumoconiosis. Methods 171 patients with dust exposed history examined with transbronehial lung biopsy, bronehoalveolar lavage and bronchial brush in- spection in our hospital during January 2008 to June 2010 were collected, then, a retrospective analysis was performed based on their bacteriological, cytological and pathological inspection combined with occupational, clinical and radiological data. Results 169 patients were obtained qualified lung samples in total 171 patients, 166 patients showed pulmonary interstitial fibrosis, among them 139 cases were lung fibroblast hyperplasia, 99 eases had collagen fiber formation; 120 patients showed some dust deposit, 40 patients had positive polariscopy check, and 48 patients were Prussian blue iron staining positive reaction. Combi- ning with those data such as occupational health surveillance, clinical medicine, imaging examination, and comparing with the diagnostic standard chest-films for pneumoeoniosis, 162 cases were diagnosed as occupational pneumoconiosis after a comprehensive analysis. Conclusion Transbronchial fiber bronchoseopy lung biopsy is a useful method for the diagnosis and differential diagnosis of pneumoeoniosis.