不同类型特发性间质性肺炎患者小气道病变的差异

Differences in small airway lesions in patients with different types of idiopathic interstitial pneumonia

目的探讨不同类型特发性间质性肺炎(IIPs)患者小气道病变的差异.方法收集1998年12月至2007年11月北京朝阳医院呼吸与危重症医学科经电视胸腔镜或小切口开胸肺活检确诊为IIPs的46例患者的临床资料,包括特发性肺纤维化(IPF)患者19例(IPF组),非特异性间质性肺炎(NSIP)患者14例(NSIP组)和隐源性(COp)患者13例(COP组).人选患者在行肺活检前行肺功能及胸部高分辨率CT(HRCT)检查,肺组织标本HE染色.比较各组患者病理、肺功能和胸部HRCT中小气道病变的差异.结果COP组小气道炎性细胞浸润评分[(53.8±17.7)分]显著高于IPF组[(38.8±9.7)分](P<0.01).IPF组小气道的纤维组织增生评分[(42.9±12.1)分]均显著高于NSIP组[(31.4±10.5)分]和COP组[(26.7±16.3)分](均P<0.05).IPF组、NSIP组和COP组小气道功能指标明显降低,25%和50%肺活量时的最大呼气流速(V25%和V50%)均<预计值80%;三组小气道功能障碍的发生率分别为63.2%、69.2%和63.6%,各组间差异均无统计学意义(均P>0.05).小气道炎性细胞浸润与小气道功能指标V50%负相关(r=-0.305,P=0.049).IPF组胸部HRCT中细支气管扩张率(100%)均显著高于NSIP组(50.0%)和COP组(53.8%)(均P<0.01).结论IPF、NSIP和COP患者病理、生理、影像方面均存在小气道病变,且具有不同的病变特征.

Objective To investigate the differences in small airway lesions in patients with different types of idiopathic interstitial pneumonia (IIPs). Methods A total of 46 patients with IIPs confirmed by video assisted thoracoscopic or open lung biopsy, hospitalized in the Respiratory and Critical Care Medicine of Beijing Chao-Yang Hospital, from Dec. 1998 through Nov. 2007 were studied, including 19 patients with idiopathic pulmonary fibrosis (IPF group), 14 with nonspecific interstitial pneumonia (NSIP group), and 13 cryptogenic organizing pneumonia (COP group). Pulmonary function and high resolution CT (HRCT) of the patients were examined before lung biopsy, and lung biopsy tissue were stained with hematoxylin-eosin. The abnormality of small airways in pathology, pulmonary function and HRCT were compared among these patients with IIPs. Results Small airway inflammatory cell infiltration score (53.8±17.7) was significantly higher in the COP group than in the IPF group (38.8±9.7)(P<0.01). The fibrous tissue proliferation score in small airways (42.9±12.1) in the IPF group was significantly higher than that in the NSIP group (31.4±10.5) and the COP group (26.7±16.3)(both P<0.05). In the IPF group, NSIP group and COP group, the small airway function index was significantly reduced, and the maximum expiratory flow rate (V25%, V50%) at 25% and 50% of the lung capacity was<80% predicted, the incidences of small airway dysfunction in the three groups were 63.2%, 69.2%, and 63.6%, respectively. There was no significant difference among the groups (P>0.05). Small airway inflammatory cell infiltration was negatively correlated with V50% of small airway function (r=-0.305, P=0.049). The bronchodilation rate in the HRCT of the IPF group (100%) was significantly higher than that of the NSIP group (50.0%) and the COP group (53.8%)(both P<0.01). Conclusion The patients with IPF, NSIP and COP have abnormal pathologic, physiological and imaging changes of small airways, moreover have different characteristics.