经支气管肺活检结合免疫组织化学方法对肺间质纤维化的诊断价值

Diagnostic value of transbronchial lung biopsy combined with immunohistochemistry in pulmonary interstitial fibrosis and the clinical significance

目的 评价经支气管肺活检 (Transbronchiallungbiopsy ,TBLB)结合免疫组织化学方法对不同原因肺间质纤维化诊断价值。方法 在X线透视下 ,对 2 0例不同原因导致的肺纤维化患者 ,包括 9例特发性肺纤维化 (IPF)和 11例COPD继发肺纤维化 (PF COPD) ,行纤维支气管镜肺活检取得肺组织 ,切片行HE染色 ,Masson三色染色及免疫组化检测I型、Ⅲ型胶原蛋白的表达 ,比较IPF与PF COPD之间在病理形态学、胶原纤维增生程度、类型及分布特点方面的区别。结果 IPF胶原纤维增生程度明显高于PF COPD(P <0 .0 1) ,IPF以较粗大的Ⅰ型胶原纤维增生为主 ;而PF COPD则以较纤细的Ⅲ型胶原纤维为主。结论 IPF与PF COPD在临床特点、病理表现、纤维增生程度及胶原纤维类型等方面均有很大的区别 ;TBLB结合免疫组化方法对肺间质纤维化具有一定的诊断价值。

Objective To evaluate the diagnostic value in pulmonary interstitial fibrosis by transbronchial lung biopsy(TBLB) and immunohistochemistry. Methods The lung tissue samples were obtained from 20 cases of pulmonary fibrosis due to different causes, including 9 cases of idiopathic pulmonary fibrosis(IPF) and 11 cases of pulmonary fibrosis caused by chronic obstructive pulmonary disease (PF COPD), by means of transbronchial lung biopsy. Hematoxylin and eosin staining, Masson trichrome staining and immunostaining with anti type Ⅲ collagen and anti type I collagen multiclonal antibodies were performed. Differences in clinical characteristics, pathological manifestations, levels, types and distribution of proliferation of collagen fibers between IPF and PF COPD were compared. Results The proliferation of collageneous fibers was significantly higher in IPF than in PF COPD( P <0.01). Type I collagen was mainly found in IPF, while type Ⅲ collagen mainly in PF COPD. Conclusion There are differences in clinical characteristics, pathological manifestations, degree and type of proliferation of collagen fibers between IPF and PF COPD. TBLB combined with immunohistochemistry is an easy and useful method for the diagnosis of pulmonary interstitial fibrosis.