支气管镜术诊断特发性肺含铁血黄素沉着症及其安全性探讨

Discussion on Bronchoscopic Diagnosis of Idiopathic Pulmonary Hemosiderosis and Its Safety

目的探讨支气管镜术诊断特发性肺含铁血黄素沉着症的阳性率及安全性。方法选取2010年1月至2013年12月在我院确诊的63例特发性肺含铁血黄素沉着症患儿为研究对象,所有患儿均行1次支气管镜术取肺泡灌洗液,2次取痰液及胃液于显微镜下寻找含铁血黄素巨噬细胞,比较不同方法的阳性率并观察支气管镜术后患儿的不良反应。结果肺泡灌洗液阳性率为82.5%,远高于痰液的44.4%及胃液的36.5%,也高于痰液胃液的联合阳性率57.1%(痰液、胃液至少有1次阳性)。支气管镜术中7例出现咳喘(经皮测血氧饱和度在90%以上),术后咳嗽加剧24例(38.1%),发热17例(27.0%),少量咯血18例(28.6%)。未做特殊处理,所有患儿48小时后症状恢复,均能耐受肺泡灌洗。结论支气管镜术可明显提高特发性肺含铁血黄素沉着症的确诊率,且安全性好,有条件的医院可作为诊疗常规推广。

Objective To investigate the positive rate and safety of diagnosis of idiopathic pulmonary hemosiderosis （IPH） by bronchoscopy. Methods 63 cases of children diagnosed with IPH in our hospital from January 2010 to December 2013 were selected. All patients received once bronchoscopy to take bronchoalveolar lavage fluid, and their sputum and gastric juice were taken twice to seek siderophages under microscope. The positive rate was compared and the adverse reactions after bronchoscopy were observed. Results The positive rate of BALF was 82.5%, significantly higher than 44.4%of the sputum and 36.5%of the gastric juice, also higher than 57.1%（at least one masculine in sputum or gastric juice） of the combination of sputum and gastric juice. 7 cases appeared with cough and asthma after bronchoscopic surgery （its transcutaneous oxygen saturation above 82.5%）, 24 cases （38.1%） coughed aggravatingly, 17 cases （27.0%） developed a fever, 18 cases （28.6%） appeared with slight hemoptysis after operation. Without making special treatment, the symptoms recovered after 48 hours. All patients could tolerate bronchoscopy lavage （BAL）. Conclusions Bronchoscopy can significantly improve the diagnosis rate of IPH with good safety, which is worthy of popularization as a routine in qualified hospitals.