支气管色素沉着纤维化与支气管结核的相关性分析

Correlation between bronchial anthracofibrosis and bronchial tuberculosis

目的:总结支气管色素沉着纤维化病例的疾病谱,探讨其与支气管结核之间的相关性。方法:连续性纳入近6年华中科技大学同济医学院附属武汉金银潭医院经支气管镜检查确诊的支气管色素沉着纤维化病例417例进行回顾性研究,根据其肺部高分辨CT、支气管镜镜检、灌洗液结核菌培养、刷检细胞学及活检病理等改变,进行支气管色素沉着纤维化与支气管结核的相关性分析。结果:417名支气管色素沉着纤维化患者中,支气管镜下诊断支气管结核249例(59.7%),所占比例明显高于其他疾病组(P<0.05),其中淋巴瘘型最多,有155例(37.2%),瘢痕狭窄型38例(9.1%),溃疡坏死型28例(6.7%),炎症浸润型20例(4.8%),肉芽增生型7例(1.7%),管壁软化型1例(0.2%);TBNA诊断胸内淋巴结核34例(8.2%);单纯肺结核81例(19.4%);排除结核病53例(12.7%),其中尘肺16例(3.8%),肺癌11例(2.6%),支气管扩张症9例(2.2%),COPD 8例(1.9%),非结核分枝杆菌病4例(1.0%),结节病3例(0.7%),气管骨化病及肺间质纤维化各1例(各占0.2%)。结论:本研究提示支气管色素沉着纤维化与支气管结核之间,尤其与淋巴瘘型支气管结核之间存在显著相关性,支气管色素沉着纤维化有可能是支气管结核的一种特殊表现形式,而结核有可能是支气管色素沉着纤维化的主要病因之一。

Objective:To summarize the disease spectrum of anthracofibrosis,and to explore its correlation with bronchial tuberculosis.Methods:A retrospective study on 417 cases of anthracofibrosis diagnosed by bronchoscopy in the Wuhan Jinyintan Hospital during last six years was carried out.Myco⁃bacterium tuberculosis culture,brush cytology,and biopsy pathology were used to analyze the correlation between anthracofibrosis and bronchial tuberculosis.Results:Among the 417 patients with anthracofibrosis,249 cases(59.7%)of bronchial tuberculosis were diagnosed by bronchoscopy,and the proportion was significantly higher than that of other disease groups(P<0.05).Among the bronchial tuberculosis cases,the lymphatic fistula was the most common type,with 155 cases(37.2%),38 cas‑es(9.1%)were in scarring stenosis type,28 cases(6.7%)were in actively caseating type,20 cases(4.8%)were in inflammatory infiltration type,7 cases(1.7%)were in granulation type,and 1 case was in airway malacia type(0.2%).A total of 34 cases(8.2%)of intrathoracic tuberculosis lymph nodes were diagnosed by TBNA;81 cases(19.4%)were simple pulmonary tuberculosis;53 cases(12.7%)were excluded,including 16 cases(3.8%)of pneumoconiosis,11 cases(2.6%)of lung cancer,9 cases of bronchiectasis(2.2%),8 cases of COPD(1.9%),4 cases of nontuberculous mycobacteriosis(1.0%),3 cases of sarcoidosis(0.7%),1 case of tracheal ossification,and 1 case of pulmonary fibrosis(each accounted for 0.2%).Conclusion:This study suggests that there is a significant correlation between anthracofibrosis and bronchial tuberculosis,especially with lymphatic fistula type of bronchial tuberculosis.Anthracofibrosis may be a special manifestation of bronchial tuberculosis,and tuberculosis may be one of the main causes of anthracofibrosis.