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经支气管冷冻肺活检诊断具有免疫特征的间质性肺炎的有效性及安全性评价
Efficacy and safety of transbronchial cryobiopsy in diagnosis of interstitial pneumonia with autoimmune features
- 第三军医大学学报 2019年41卷第17期 页码：1682-1687
- 作者机构：
1.400016 重庆，重庆医科大学附属第一医院:呼吸与危重症学科
2.400016 重庆，重庆医科大学附属第一医院:放射科
3.400016 重庆，重庆医科大学附属第一医院:病理科
- 作者简介：
[ 郭述良，E-mail:GUOSL999@sina.com GUO Shuliang, E-mail:GUOSL999@sina.com
- 基金信息：重庆市卫计委首批中青年医学高端人才工作室项目(渝卫人〔2018〕2号);重庆市卫计委2016年适宜卫生技术推广项目(2016jstg005)
DOI：10.16016/j.1000-5404.201904095
中图分类号： R181.32;R446.8;R563.13收稿：2019-04-11，
修回：2019-06-03，
纸质出版：2019-09-15
- 稿件说明：
移动端阅览
江涛, 郭述良, 李一诗, 等. 经支气管冷冻肺活检诊断具有免疫特征的间质性肺炎的有效性及安全性评价[J]. 第三军医大学学报, 2019,41(17):1682-1687.
Tao JIANG, Shuliang GUO, Yishi LI, et al. Efficacy and safety of transbronchial cryobiopsy in diagnosis of interstitial pneumonia with autoimmune features[J]. Journal of Third Military Medical University, 2019, 41(17): 1682-1687.
江涛, 郭述良, 李一诗, 等. 经支气管冷冻肺活检诊断具有免疫特征的间质性肺炎的有效性及安全性评价[J]. 第三军医大学学报, 2019,41(17):1682-1687. DOI： 10.16016/j.1000-5404.201904095.
Tao JIANG, Shuliang GUO, Yishi LI, et al. Efficacy and safety of transbronchial cryobiopsy in diagnosis of interstitial pneumonia with autoimmune features[J]. Journal of Third Military Medical University, 2019, 41(17): 1682-1687. DOI： 10.16016/j.1000-5404.201904095.
摘要
目的
2
分析经支气管冷冻肺活检(transbronchial cryobiopsy，TBCB)诊断的具有自身免疫特征的间质性肺炎(interstitial pneumonia with autoimmune features，IPAF)病例资料，评价TBCB诊断IPAF的有效性及安全性。
方法
2
从2015年4月至2018年12月，针对原因不明的间质性肺疾病(interstitial lung disease
ILD)患者实施TBCB检查并从中筛选出符合IPAF诊断标准的病例，收集并分析其临床、影像学及病理资料，评价TBCB对IPAF的诊断效能，记录TBCB的并发症。
结果
2
从83例接受TBCB检查的患者中，采用临床-影像-病理诊断模式(clinico-radiologic-pathologic diagnosis，CRP)筛选出15例符合诊断的IPAF病例，而采用临床-影像模式(CR)仅筛选出8例符合诊断的IPAF病例。TBCB检查时间为(31.7±14.2) min，取得的标本大小为10(7，15) mm
2
。1例患者在术后发生轻度气胸
经过吸氧后气胸吸收；15例患者术中出现不同程度出血(轻中度出血14例，重度出血1例)，经止血处理后出血停止。IPAF患者呼吸系统主要症状为咳嗽和呼吸困难，免疫系统表现有技工手、雷诺现象、口干眼干等。血清学检查以抗核抗体阳性及
抗R0-52抗体阳性常见，分别有12例(80.0%)和10例(66.7%)。肺功能以弥散功能下降为主，6 min步行距离为(388.5±88.4) m。胸部高分辨率CT(high resolution computed tomography
HRCT)及病理学检查以非特异性间质性肺炎(non-specific interstitial pneumonia
NSIP)表现为主。
结论
2
TBCB可提高IPAF诊断率且具有良好的安全性。
Abstract
Objective
2
To evaluate the effectiveness and safety of transbronchial cryobiopsy (TBCB) in the diagnosis of interstitial pneumonia with autoimmune features (IPAF).
Methods
2
From December 2015 to December 2018
TBCB was performed in the patients with interstitial lung disease of uncertain origin. The cases within the IPAF diagnostic criteria were selected
and their clinical
radiological and pathological data were collected and analyzed to evaluate the diagnostic effect of TBCB for IPAF. The complications of TBCB were recorded.
Results
2
Among the 83 cases undergoing TBCB
15 eligible IPAF cases were screened out by a mode of clinical-radiological-pathological diagnosis (CRP)
while only 8 cases were diagnosed as IPAF with clinical-radiological diagnosis (CR). It took averagely 31.7±14.2 min for TBCB procedure
and the medium area of the obtained specimens was 10 (7
15) mm
2
. One patient developed mild pneumothorax after the procedure
which was absorbed after oxygen inhalation. Hemorrhage of different volumes occurred during the procedure (1 case of severe hemorrhage) in 15 patients
which was controlled with hemostatic measures. The common initial symptoms were cough and dyspnea. The most common manifestations in immune system were technician hand
Raynaud phenomenon
and dry mouth and dry eye and so on. Serological tests were positive to antinuclear antibodies in 12 cases (80%) and to anti-R0-52 antibodies in 10 cases (66.7%). The main pulmonary function deficiencies were decrease in diffuse function
and the average 6-minute-walking distance was 388.5±88.4 m. The main features on chest
high resolution computed tomography (HRCT) and pathological examination were as those of non-specific interstitial pneumonia (NSIP).
Conclusion
2
TBCB improves the diagnostic rate of IPAF with a satisfactory safety.
关键词
Keywords
references
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