支气管镜对不同类型肺结节病诊断价值.PDF

《现代仪器与医疗》 2018年  第24卷   第4期 临床研究 支气管镜对不同类型肺结节病的诊断价值 刘易其 西昌市人民医院呼吸内科，四川西昌　615000 [摘　要]　目的：分析支气管镜对不同类型肺结节病的诊断价值。方法：研究病例为 187 例已确诊为肺结节病 且排除合并结核、外源性肺泡炎、职业性铍病、矽肺等其他肺内肉芽肿性疾病的患者。按照支气管镜下肺结节 病灶表现，分为典型粘膜改变组、非典型粘膜改变组，对比支气管粘膜活检（EBB ）、经支气管肺活检（TBLB ）、 经支气管超声内镜引导针吸活检（EBUS-TBNA ）三种不同取材方法诊断不同类型肺结节病的阳性率。对比两 组患者支气管肺泡灌洗液（Bronchoalveolar Lavage Fluid,BALF ）改变特点。结果：84.34% （140/166 ）患者淋 巴细胞比例≥28% ，58.28% （109/187 ）患者CD4+/CD8+ 比值≥4 ，典型粘膜改变组淋巴细胞比例≥28% 的比 率、CD +/CD + 比值≥2 的比率均高于非典型粘膜改变组，差异有统计学意义（ ＜0.05 ）。EBB、EBB+TBLB、 4 8 P EBB+EBUS-TBNA 诊断典型粘膜改变的阳性率高于非典型粘膜改变，TBLB、EBUS-TBNA、TBLB+EBUS- TBNA 诊断非典型粘膜改变的阳性率高于典型粘膜改变，差异有统计学意义（ ＜0.05 ）。结论：对于伴典型 P 粘膜改变的肺结节病而言，选用EBB 取材即可为临床诊断提供可靠参考；对于非典型粘膜改变，应考虑联合 BALF 、TBLB、TBUS-TBNA 等多种检查及取材方式。 [关键词]　支气管镜；活检；肺结节病；诊断 中图分类号：R563.9　文献标识码：A　文章编号：2095-5200(2018)04-065-03 DOI：10.11876/mimt201804027 Bronchoscopic diagnosis of sarcoidosis　LIU Yiqi. Department of respiration, Xichang People’s Hospital, Xichang 615000, China [Abstract]　Objective: The objective of this study was to analyze the diagnostic value of bronchoscope in sarcoidosis. Methods: After removing the tuberculosis, extrinsic alveolitis, occupational beryllium disease, silicosis and other pulmonary granulomatous disease patients, a total of 187 confirmed sarcoidosis patients were selected. Based on the lesion manifestation under the bronchoscope, the patients were divided into typical mucosa altered group, non- typical mucosa altered group. endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosing the positive were compared. And the characteristics of bronchoalveolar lavage fluid (BALF) were compared between these two groups.