173例经支气管镜冷冻肺活检在弥漫性肺疾病中的病理诊断分析

刘春平; 顾莹莹; 李时悦; 陈小波; 李龙光; 姜桔红; 赵瑾; 付琳; 李梦诗; 陈朱诚

doi:10.3760/cma.j.issn.1001-0939.2020.03.018

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中华结核和呼吸杂志

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ENGLISH ABSTRACT

173例经支气管镜冷冻肺活检在弥漫性肺疾病中的病理诊断分析

作者及单位信息

出版日期： 2020 -03 -12 ·

DOI： 10.3760/cma.j.issn.1001-0939.2020.03.018

Transbronchial lung cryobiopsy in diffuse lung disease: a pathological analysis of 173 cases

Authors Info & Affiliations

Liu Chunping

State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Pathology Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510090, China

Gu Yingying

Li Shiyue

Chen Xiaobo

Li Longguang

Jiang Juhong

Zhao Jin

Fu Lin

Li Mengshi

Chen Zhucheng

Published： 2020 -03 -12 ·

DOI： 10.3760/cma.j.issn.1001-0939.2020.03.018

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摘要

目的探讨经支气管镜冷冻肺活检技术（TBCB）对肺部弥漫性疾病（DLD）病理诊断的价值。

方法收集广州医科大学附属第一医院2017年1月—2019年6月173例病因诊断不明需行TBCB检查的住院患者的临床病理资料，进行回顾性分析及总结，其中54例同时行TBCB和常规经支气管镜肺活检（TBLB），比较两者活检方法标本大小及病理诊断效率。

结果173例TBCB标本中，结合患者年龄、性别、职业、既往史、接触史、吸烟史、实验室血清学及影像学结果，最终病理组织学检查明确分型者有148例（85.5%），病理明确分型或有提示诊断者160例（92.5%），其中已知病因为72例（45.0%）；特发性间质性肺炎27例（16.9%）；7例肉芽肿性病变（4.4%）；其他类型54例（33.8%）。173例中54例同时行TBCB和TBLB，TBCB组和TBLB组标本的大小分别为（3.3±1.3）和（1.0±0.3）mm ²（ t′=12.67， P<0.01）。TBCB组和TBLB组明确病理分型诊断效率分别为81.5%（44/54）和42.6%（23/54），差异有统计学意义（χ ²=17.33， P<0.01）。其中TBCB组与TBLB组对间质性肺疾病明确分型的病理诊断效率分别为48.2%（26/54）和5.6%（3/54），差异有统计学意义（χ ²=24.94， P<0.01）。而TBCB组与TBLB组诊断除间质性肺疾病以外的其他弥漫性肺疾病的病理诊断效率分别为33.33%（18/54）和37.04%（20/54），差异无统计学意义（χ ²=0.1624， P=0.687）。

结论与TBLB相比较，TBCB所获得的标本大小及在确诊弥漫性肺疾病特别是间质性肺疾病分型上具有明显优势和应用价值。

关键词：肺疾病，弥漫性;冷冻，活组织检查;支气管镜检查;诊断

ABSTRACT

ObjectiveTo evaluate the value of transbronchial lung cryobiopsy (TBCB) in pathological diagnosis for diffuse lung disease.

MethodsThe clinicopathological data of 173 patients from the first affiliated hospital of Guangzhou medical university between Jaunary 2017 and June 2019 with transbronchial lung cryobiopsy of diffuse lung disease were retrospectively analyzed and summarized with review. Among 173 cases, TBCB and conventional transbronchial lung biopsy (TBLB) were performed in 54 patients. The size of biopsy samples and diagnostic yield were compared.

ResultsAmong 173 cases, the diagnostic yield was 85.54% (148/173) , 160 (92.49%) cases provided definite diagnosis and valuable pathological results, according to age, sex, occupation, past history, contact history, smoking history, laboratory serology and imaging findings. Among 160 cases, there were 72 cases of known etiology (45.00%), 27 cases of idiopathic interstitial pneumonia (16.88%), 7 cases of granulomatous lesions (4.38%) and 54 cases of other types (33.75%). With TBCB and TBLB in 54 patients, the specimens sizes of TBCB and TBLB were (3.3±1.3) mm ² and (1.0±0.3) mm ² respectively ( t′=12.67 P<0.01) . The diagnostic yields of TBCB and TBLB were 81.48% (44/54) and 42.59% (23/54) respectively (χ ²=17.33, P<0.01) . The diagnostic yields of TBCB and TBLB for interstitial lung diseases were 48.15% (26/54) and 5.56% (3/54) respectively (χ ²=24.94, P<0.01) . However, the diagnostic yields of TBCB and TBLB for the other diffuse lung disease except interstitial lung diseases were 33.33% (18/54) and 37.04% (20/54) respectively, with no significant difference (χ ²=0.1624, P=0.687).

ConclusionCompared with TBLB, TBCB has obvious advantages and application value in the diagnosis of diffuse pulmonary diseases, especially interstitial pulmonary diseases.

KEYWORDS： Lung disease, diffuse;Freezing, biopsy;Bronchoscopy;Dignosis

Corresponding author: Gu Yingying, Email: mocdef.3ab6109832101631

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引用本文

刘春平,顾莹莹,李时悦,等. 173例经支气管镜冷冻肺活检在弥漫性肺疾病中的病理诊断分析[J]. 中华结核和呼吸杂志,2020,43(03)：228-233.

DOI:10.3760/cma.j.issn.1001-0939.2020.03.018

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除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

弥漫性肺疾病（diffuse lung disease，DLD）种类繁多、病因复杂，多学科讨论对确诊疾病性质是必要的。尽管部分病例可以通过临床、影像及实验室检查得以确诊，但大部分患者仍需要结合上述检查结果，最终通过组织病理学才能明确诊断。经支气管镜肺活检（transbronchial lung biopsy，TBLB）有利于诊断小叶中心性的DLD、肉芽肿、机化性肺炎或肿瘤性病变，但如病变位于次级肺泡的外周或存在异质性需更多肺泡组织才能获得诊断时却很困难，加之获取的组织标本小，部分标本挤压变形，难以满足DLD的病理诊断的需要 ^{[
1
]}。一直被认为诊断DLD金标准的外科肺活检，因创伤大、费用高、受多处取材及患者心肺功能等因素的限制了其应用 ^{[
2
]}。经支气管镜冷冻技术（transbronchial cryobiopsy，TBCB）始于1968年，自20世界70年代以来该技术逐渐被临床应用，最初应用肿瘤的消融治疗，后来广泛应用于气道占位性疾病的介入治疗，过去十年才用于获取更大的组织标本 ^{[
3
,

4
]}。该方法是利用可弯曲的冷冻探针在支气管镜的引导下、高压枪发射出NO、CO ₂气体瞬间温度达-50~-90 ℃，冷冻探针接触的组织迅速冷冻致缺血坏死，取下的标本足够大且内部组织结构破坏少而备受关注 ^{[
5
,

6
,

7
,

8
]}，TBCB不仅可以运用于肺部肿瘤、气道性疾病及肺移植后的监测，更适用于间质性肺疾病的病理诊断 ^{[
6
,

9
,

10
]}，但该技术在国内尚未全面开展。本研究回顾分析173例TBCB的临床病理诊断资料进行总结分析，其中54例同时行TBCB和TBLB检查，比较TBCB和TBLB对DLD的明确分型病理诊断效率，从而探讨TBCB在确诊DLD性质的诊断价值。

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参考文献

参考文献

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