高级检索
中华结核和呼吸杂志
期刊首页
过刊列表
高级检索
稿件发表
• 论著 •
ENGLISH ABSTRACT
外科肺活检在诊断弥漫性实质性肺疾病中的价值：单中心28年来疾病谱变化
彭敏
许文兵
徐作军
蔡柏蔷
朱元珏
刘鸿瑞
张伟宏
宋兰
王孟昭
李单青
施举红
冯瑞娥
作者及单位信息
·
DOI： 10.3760/cma.j.cn112147-20211012-00712
Diagnostic value of surgical lung biopsies for diffuse parenchymal lung disease: the change of disease spectrum in the past 28 years in a single institution in China
Peng Min
Xu Wenbing
Xu Zuojun
Cai Baiqiang
Zhu Yuanjue
Liu Hongrui
Zhang Weihong
Song Lan
Wang Mengzhao
Li Shanqing
Shi Juhong
Feng Ruie
Authors Info & Affiliations
Peng Min
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Xu Wenbing
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Xu Zuojun
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Cai Baiqiang
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Zhu Yuanjue
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Liu Hongrui
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Zhang Weihong
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Song Lan
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Wang Mengzhao
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Li Shanqing
Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Shi Juhong
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Feng Ruie
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
·
DOI： 10.3760/cma.j.cn112147-20211012-00712
892
166
0
1
4
1
PDF下载
APP内阅读
摘要

目的观察经外科肺活检诊断弥漫性实质性肺疾病（DPLD）的疾病谱变迁并探讨外科肺活检在DPLD中的诊断价值。

方法回顾性分析北京协和医院1993年1月至2020年12月28年间连续455例接受外科肺活检的DPLD病例资料，其中男211例，女244例，接受活检时年龄（45±14）岁。按照1993—2002、2003—2012、2013—2020年分为3个时间段进行疾病谱比较。

结果411例（411/455，90.3%）经病理形态学明确诊断，441例（441/455，96.9%）经临床-影像-病理多学科讨论后确诊。术后30 d病死率为2.4%（11/455），术后3个月病死率为3.3%（15/455）。本组患者中间质性肺炎209例（209/455，45.9%），其中非特异性间质性肺炎105例，寻常性间质性肺炎33例；其他类型DPLD为166例（166/455，36.5%），其中过敏性肺炎49例；肿瘤39例（39/455，8.6%）；感染性疾病27例（27/455，5.9 %）。1993—2002、2003—2012、2013—2020年外科肺活检数量分别为76例（76/455，16.7%）、297例（297/455，65.3%）和82例（82/455，18%）。在上述3个时间段内，间质性肺炎占DPLD的比例分别为68.4%、45.1%和28.0%，其他类型DPLD为22.4%、39.4%和39.0%，肿瘤为2.6%、7.4%和18.3%，感染为5.3%、5.1%和9.8%。

结论DPLD外科肺活检疾病谱随时间的变化反映了临床医生对DPLD和间质性肺炎认识不断深入的过程以及诊治策略的变化。对于某些疑难的、诊断困难、治疗方向不明的DPLD，外科肺活检仍然具有重要价值。

间质性肺炎;外科肺活检;弥漫性实质性肺疾病
ABSTRACT

ObjectiveTo investigate the changes of disease spectrum in diffuse parenchymal lung disease (DPLD) diagnosed by surgical lung biopsy, and to explore the diagnostic value of surgical lung biopsy in DPLD.

MethodsFour hundred and fifty-five consecutive DPLD patients, who underwent surgical lung biopsy in Peking Union Medical College Hospital during the past 28 years, were analyzed retrospectively.

ResultsThere were 211 males and 244 females. The average age at biopsy was (45±14) years. Four hundred and eleven cases (90.3%) were diagnosed by pathologic findings. Four hundred and forty-one cases (96.9%) were diagnosed by clinical-radiologic-pathologic multidisciplinary discussion. The 30-day mortality and 90-day mortality were 2.4% and 3.3% respectively. The disease spectrum included interstitial pneumonia in 209 cases (45.9%) (nonspecific interstitial pneumonia in 105 cases, usual interstitial pneumonia in 33 cases), other miscellaneous DPLD in 166 cases (36.5%) (including hypersensitivity pneumonitis in 49 cases), tumor in 39 cases (8.6%), and infectious diseases in 27 cases (5.9%). In the three consecutive periods (1993-2002, 2003-2012 and 2013-2020), the number of biopsies was 76 (16.7%), 297 (65.3%) and 82 (18%) respectively. The disease spectrum changes over time: in the above three periods, the percentage of interstitial pneumonia in DPLD was 68.4%, 45.1% and 28%, other miscellaneous DPLDs were 22.4%, 39.4% and 39.0%, the tumors were 2.6%, 7.4% and 18.3%, the infectious diseases were 5.3%, 5.1% and 9.8%.

ConclusionsThis study presented the changes of disease spectrum in DPLD diagnosed by surgical lung biopsy through single center real-world data, reflecting the progress of clinicians′ understanding of DPLD and interstitial pneumonia. Surgical lung biopsy is still valuable for some difficult and complicated DPLD cases.

Interstitial pneumonia;Surgical lung biopsy;Diffuse parenchymal lung disease
Shi Juhong, Email: nc.defhcabmuphjihs
Feng Ruie, Email: mocdef.3ab611eiurgnef
Copyright by Chinese Medical Association
No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.
All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

彭敏,许文兵,徐作军,等. 外科肺活检在诊断弥漫性实质性肺疾病中的价值：单中心28年来疾病谱变化[J]. 中华结核和呼吸杂志,2022,45(03)：255-260.

DOI:10.3760/cma.j.cn112147-20211012-00712

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

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。

弥漫性实质性肺疾病（diffuse parenchymal lung disease，DPLD）是一组肺部疾病的统称，在病因、临床表现、影像学特征和组织病理学方面存在很大差异。对DPLD 的具体类型做出明确诊断对于制定准确治疗方案至关重要。
部分DPLD确诊需要肺组织活检获得病理证据。经支气管肺活检（TBLB）创伤性相对较小，结合临床表现和高分辨率CT（HRCT），对感染、肿瘤及某些特殊类型的DPLD：结节病、过敏性肺炎、嗜酸粒细胞肺炎、肺泡蛋白沉积症、机化性肺炎、肺朗格汉斯细胞组织细胞增生症和淋巴管肌瘤病（LAM）具有诊断价值 ［ 1 ］ ；经皮肺穿刺活检对病变以外周分布为主的DPLD有一定的诊断价值 ［ 2 ］ 。然而TBLB 或经皮肺穿刺活检所获得的小标本对于诊断间质性肺炎的具体类型价值有限。
外科肺活检（surgical lung biopsy，SLB）对DPLD的诊断价值较大 ［ 3 , 4 , 5 , 6 , 7 , 8 ］ ，文献报道超过90%的DPLD病例经SLB确诊 ［ 3 ］ ，但约10%的DPLD患者即使通过SLB仍不能明确诊断。另外，SLB属于有创检查，开放性肺活检（OLB）和电视辅助胸腔镜手术（VATS）活检的30 d病死率分别为4.3% 和2.1%，非致死性并发症发生率分别为18.1%和9.6% ［ 3 ］ ，在临床实践中需要谨慎地平衡 SLB 的风险和收益。
近30年来，无论是国际上还是国内的临床医生对于DPLD的认识都在不断加深，关于肺间质病的共识和指南不断更新 ［ 7 , 8 , 9 , 10 , 11 , 12 , 13 ］ 。时至今日，SLB对于DPLD的诊断是否还处于绝对优势地位，何种DPLD仍需通过SLB明确诊断，如何处理SLB病理不能确诊的患者等是临床需要面对和思考的问题。
本文回顾了1993—2020年北京协和医院行SLB的DPLD患者资料，分析其疾病谱构成；观察活检数量及疾病谱随时间的变化过程，探索随时间变迁SLB病理对DPLD诊断作用及价值；为今后更严格掌握适应证，避免不必要的创伤性检查。
参考文献
[1]
施举红,许文兵,朱元珏,等. 经支气管镜肺活检对弥漫性肺实质疾病的诊断价值[J]. 中华结核和呼吸杂志, 2008, (1):22-25.
返回引文位置Google Scholar
百度学术
万方数据
[2]
彭敏,许文兵,施举红,等. CT引导下经皮肺活检在弥漫性实质性肺疾病的临床应用[J]. 中华结核和呼吸杂志, 2012, (3):171-175.
返回引文位置Google Scholar
百度学术
万方数据
[3]
Nguyen W , Meyer KC . Surgical lung biopsy for the diagnosis of interstitial lung disease: a review of the literature and recommendations for optimizing safety and efficacy[J]. Sarcoidosis Vasc Diffuse Lung Dis, 2013,30(1):3-16.
返回引文位置Google Scholar
百度学术
万方数据
[4]
Morris D , Zamvar V . The efficacy of video-assisted thoracoscopic surgery lung biopsies in patients with Interstitial Lung Disease: a retrospective study of 66 patients[J]. J Cardiothorac Surg, 2014,9:45. DOI: 10.1186/1749-8090-9-45 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Samejima J , Tajiri M , Ogura T ,et al. Thoracoscopic lung biopsy in 285 patients with diffuse pulmonary disease[J]. Asian Cardiovasc Thorac Ann, 2015,23(2):191-197. DOI: 10.1177/0218492314550724 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Sugino K , Otsuka H , Matsumoto Y ,et al. The role of video-assisted thoracoscopic surgery in the diagnosis of interstitial lung disease[J]. Sarcoidosis Vasc Diffuse Lung Dis, 2019,36(2):148-156. DOI: 10.36141/svdld.v36i2.7797 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
American Thoracic Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement. American Thoracic Society (ATS), and the European Respiratory Society (ERS)[J]. Am J Respir Crit Care Med, 2000,161(2Pt 1):646-664. DOI: 10.1164/ajrccm.161.2.ats3-00 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
American Thoracic Society,European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001[J]. Am J Respir Crit Care Med, 2002,165(2):277-304. DOI: 10.1164/ajrccm.165.2.ats01 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Raghu G , Collard HR , Egan JJ ,et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management[J]. Am J Respir Crit Care Med, 2011,183(6):788-824. DOI: 10.1164/rccm.2009-040GL .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Travis WD , Costabel U , Hansell DM ,et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias[J]. Am J Respir Crit Care Med, 2013,188(6):733-748. DOI: 10.1164/rccm.201308-1483ST .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Fischer A , Antoniou KM , Brown KK ,et al. An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features[J]. Eur Respir J, 2015,46(4):976-987. DOI: 10.1183/13993003.00150-2015 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Raghu G , Remy-Jardin M , Ryerson CJ ,et al. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline[J]. Am J Respir Crit Care Med, 2020,202(3):e36-e69. DOI: 10.1164/rccm.202005-2032ST .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Raghu G , Remy-Jardin M , Myers JL ,et al. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline[J]. Am J Respir Crit Care Med, 2018,198(5):e44-e68. DOI: 10.1164/rccm.201807-1255ST .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Qureshi RA , Ahmed TA , Grayson AD ,et al. Does lung biopsy help patients with interstitial lung disease?[J]. Eur J Cardiothorac Surg, 2002,21(4):621-626; discussion 626. DOI: 10.1016/s1010-7940(02)00021-0 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Yamaguchi M , Yoshino I , Suemitsu R ,et al. Elective video-assisted thoracoscopic lung biopsy for interstitial lung disease[J]. Asian Cardiovasc Thorac Ann, 2004,12(1):65-68. DOI: 10.1177/021849230401200116 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Kreider ME , Hansen-Flaschen J , Ahmad NN ,et al. Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease[J]. Ann Thorac Surg, 2007,83(3):1140-1144. DOI: 10.1016/j.athoracsur.2006.10.002 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Sigurdsson MI , Isaksson HJ , Gudmundsson G ,et al. Diagnostic surgical lung biopsies for suspected interstitial lung diseases: a retrospective study[J]. Ann Thorac Surg, 2009,88(1):227-232. DOI: 10.1016/j.athoracsur.2009.04.002 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Blackhall V , Asif M , Renieri A ,et al. The role of surgical lung biopsy in the management of interstitial lung disease: experience from a single institution in the UK[J]. Interact Cardiovasc Thorac Surg, 2013,17(2):253-257. DOI: 10.1093/icvts/ivt217 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Luo Q , Han Q , Chen X ,et al. The diagnosis efficacy and safety of video-assisted thoracoscopy surgery (VATS) in undefined interstitial lung diseases: a retrospective study[J]. J Thorac Dis, 2013,5(3):283-288. DOI: 10.3978/j.issn.2072-1439.2013.04.12 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Fernández Pérez ER , Travis WD , Lynch DA ,et al. Executive Summary: Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report[J]. Chest, 2021,160(2):595-615. DOI: 10.1016/j.chest.2021.03.067 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A

彭敏：研究实施，分析统计数据并起草文章；许文兵、刘鸿瑞、徐作军、蔡柏蔷和朱元珏：对研究提供支持并对文章的知识性内容作批判性审阅；张伟宏、宋兰、李单青：分析数据并提供技术支持；施举红：研究设计和实施、数据采集、文章撰写并协助数据分析；王孟昭：对研究提供行政、技术支持；冯瑞娥：分析数据并对文章的知识性内容作批判性审阅

B
施举红，Email： nc.defhcabmuphjihs
C
冯瑞娥，Email： mocdef.3ab611eiurgnef
D

彭敏, 许文兵, 徐作军, 等. 外科肺活检在诊断弥漫性实质性肺疾病中的价值: 单中心28年来疾病谱变化[J]. 中华结核和呼吸杂志, 2022, 45(3): 255-260. DOI: 10.3760/cma.j.cn112147-20211012-00712.

E
所有作者声明无利益冲突
评论 （0条）
注册
登录
时间排序
暂无评论，发表第一条评论抢沙发
最新推荐
更多
缺血伴非阻塞性冠状动脉疾病诊断及管理中国专家共识
中华医学会心血管病学分会 等
中华心血管病杂志 2022,50(12)
子宫腺肌病伴不孕症诊疗中国专家共识
子宫腺肌病伴不孕症诊疗中国专家共识编写组
中华生殖与避孕杂志 2021,41(04)
伴JAK2 V617F突变的慢性粒细胞白血病一例并文献复习
李章坤 等
白血病·淋巴瘤 2019,28(05)
慢性粒细胞白血病伴脑出血二例并文献复习
赵盟 等
白血病·淋巴瘤 2019,28(01)
MedAI助手（体验版）
文档即答
智问智答
机器翻译
回答内容由人工智能生成，我社无法保证其准确性和完整性，该生成内容不代表我们的态度或观点，仅供参考。
生成快照
文献快照

你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持：

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号
小中大