经支气管肺活检结合肺泡灌洗在隐源性机化性肺炎中的诊断价值

Diagnostic value of combination transbronchial lung biopsy with bronchoalveolar lavage in patients with cryptogenic organizing pneumonia

目的探讨纤维支气管镜下经支气管肺活检结合肺泡灌洗对隐源性机化性肺炎的诊断价值。方法选择我院病理证实的隐源性机化性肺炎患者19例,对患者临床特征、实验室检查、影像学资料、气管镜检查进行回顾性分析。结果隐源性机化性肺炎主要呼吸道症状是干咳少痰,其次是胸闷气短,分别占89.47%和68.42%,全身症状主要为发热、乏力,分别占73.68%和47.37%,大约63.16%的患者肺部可听到爆裂音;实验室检查常见血沉增快,C反应蛋白升高;肺功能检查提示为弥散及限制性通气功能障碍;高分辨率CT最常见为双肺胸膜下沿气管血管束分布的多发斑片状影及磨玻璃影;肺泡灌洗液中T细胞亚群提示CD4/CD8降低(<1.0),绝大多数病例可经支气管肺活检(TBLB)获得组织病理诊断,TBLB结合肺泡灌洗并发症仅有少数发热、痰中带血,或偶有气胸发生。结论支气管镜下肺泡灌洗和TBLB安全、可靠。尽早行肺泡灌洗及TBLB检查对隐源性机化性肺炎明确诊断有重要意义。

Objective To explore the clinical diagnostic value of combination transbronchial lung biopsy with bronchoalveolar lavage in patients with cryptogenic organizing pneumonia(COP). Methods Nineteen COP with biopsy-provencases were retrospectively analyzed for clinical performance, library examinations, lung functiontest and chest high-resolution computed tomography(HRCT), as well as confirmed diagnosis by transbronchial lung biopsy (TBLB). Results The mainly symptoms of respiratory system for dry cough with little sputum, short of breath or dyspnea accounted for 89.47% and 68.42% respectively.Systemic symptoms were fever and fatigue, 73.68% and 47.37% respectively.Velcro crackles on auscultation were for 63.16% cases.Erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP) increased for 68.42% and 52.63% respectively.Diffusion and restrictive ventilation dysfunctions were showed in 89.47% and 63.16% respectively.The most common chest radiographic abnormalities of COP were bilateral and multifocal areas of patchy consolidation, 1inear shadows and ground-glass opacity.T cell subsets in bronchoalvedar lavage fluid (BALF) showed a decrease in CD4/CD8 (<1.0). Positively pathological results could be obtained by TBLB for most cases.Complications of TBLB and bronchial alveolar lavage (BAL) were rare.Only a few fevers, blood in the sputum, or occasional pneumothorax occurred. Conclusions BAL and TBLB via fiberbronchoscope are safe and reliable.Early alveolar lavage and TBLB examination are important for the diagnosis of cryptogenic organizing pneumonia.