[1]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.
 JIANG Tao,GUO Shuliang,LI Yishi,et al.Efficacy and safety of transbronchial cryobiopsy in diagnosis of interstitial pneumonia with autoimmune features[J].J Third Mil Med Univ,2019,41(17):1682-1687.
点击复制

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(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第17期
页码:
1682-1687
栏目:
临床医学
出版日期:
2019-09-15

文章信息/Info

Title:
Efficacy and safety of transbronchial cryobiopsy in diagnosis of interstitial pneumonia with autoimmune features
作者:
江涛郭述良李一诗江瑾玥敖知肖洋李琦褚志刚李娴李玲玉
重庆医科大学附属第一医院:呼吸与危重症学科1,放射科2,病理科3
Author(s):
JIANG Tao1 GUO Shuliang1 LI Yishi1 JIANG Jinyue1 AO Zhi1 XIAO Yang1 LI Qi2 CHU Zhigang2 LI Xian3 LI Lingyu3

1Department of Respiratory and Critical Care Medicine, 2Department of Radiology, 3Department of Pathology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

关键词:
影像引导活检具有自身免疫特征的间质性肺炎诊断
Keywords:
lungs image-guided biopsy interstitial pneumonia with autoimmune features diagnosis
分类号:
R181.32; R446.8; R563.13
文献标志码:
A
摘要:

目的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) mm2。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TBCB可提高IPAF诊断率且具有良好的安全性

Abstract:

ObjectiveTo evaluate the effectiveness and safety of transbronchial cryobiopsy (TBCB) in the diagnosis of interstitial pneumonia with autoimmune features (IPAF). MethodsFrom 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. ResultsAmong 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) mm2. 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). ConclusionTBCB improves the diagnostic rate of IPAF with a satisfactory safety.

参考文献/References:

[1]FISCHER A, ANTONIOU K M, BROWN K K, 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.
[2]CASCANTE J A, CEBOLLERO P, HERRERO S, et al. Transbronchial cryobiopsy in interstitial lung disease[J]. J Bronchol Interv Pulmonol, 2016, 23(3): 204-209. DOI:10.1097/lbr.0000000000000292.
[3]HAGMEYER L,THEEGARTEN D,WOHLSCHLGER J, et al. The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease[J]. Clin Respir J, 2016, 10(5): 589-595. DOI:10.1111/crj.12261.
[4]江瑾玥, 郭述良, 李一诗. 经支气管冷冻肺活检技术进展[J]. 中华结核和呼吸杂志, 2017, 40(8): 619-622. DOI:10.3760/cma.j.issn.1001-0939.2017.08.015.
JIANG J Y, GUO S L, LI Y S. Advance in transbronchial cryobiopsy [J]. Chin J Tuberc Respir Dis, 2017, 40(8): 619-622. DOI:10.3760/cma.j.issn.1001-0939.2017.08.015.
[5]李一诗, 郭述良, 曹友德. 经支气管冷冻肺活检二例[J]. 中华结核和呼吸杂志, 2016, 39(11): 905-907. DOI:10.3760/cma.j.issn.1001-0939.2016.11.020.
LI Y S, GUO S L, CAO Y D. Two cases of transbronchial cryobiopsy [J]. Chin J Tuberc Respir Dis, 2016, 39(11): 905-907. DOI:10.3760/cma.j.issn.1001-0939.2016.11.020.
[6]BABIAK A, HETZEL J, KRISHNA G, et al. Transbronchial cryobiopsy: a new tool for lung biopsies[J]. Respiration, 2009, 78(2): 203-208. DOI:10.1159/000203987.
[7]ING M, OLIVER R A, OLIVER B G, et al. Evaluation of transbronchial lung cryobiopsy size and freezing time: A prognostic animal study[J]. Respiration, 2016, 92(1): 34-39. DOI:10.1159/000447329.
[8]DU RAND I A, BLAIKLEY J, BOOTON R, et al. Summary of the British thoracic society guideline for diagnostic flexible bronchoscopy in adults[J]. Thorax, 2013, 68(8): 786-787. DOI:10.1136/thoraxjnl-2013-203629.
[9]TRAVIS W D, COSTABEL U, HANSELL D M, 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.
[10]AHMAD K, BARBA T, GAMONDES D, et al. Interstitial pneumonia with autoimmune features: Clinical, radiologic, and histological characteristics and outcome in a series of 57 patients[J]. Respir Med, 2017, 123: 56-62. DOI:10.1016/j.rmed.2016.10.017.
[11]BALIAKA A, PAPAEMMANOUIL S, PASTELLI N, et al. Idiopathic interstitial pneumonias: clinico-radiologic-pathologic diagnosis[J]. J Thorac Dis, 2015,7(Suppl 1): AB019.DOI:10.3978/j.issn.2072-1439.2015.AB019.
[12]CASONI G L, TOMASSETTI S, CAVAZZA A, et al. Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases[J]. PLoS ONE, 2014, 9(2): e86716. DOI:10.1371/journal.pone.0086716.
[13]YARMUS L, AKULIAN J, GILBERT C, et al. Cryoprobe transbronchial lung biopsy in patients after lung transplantation: a pilot safety study[J]. Chest, 2013, 143(3): 621-626. DOI:10.1378/chest.12-2290.
[14]SCHUHMANN M, BOSTANCI K, BUGALHO A, et al. Endobronchial ultrasound-guided cryobiopsies in peripheral pulmonary lesions: a feasibility study[J]. Eur Respir J, 2014, 43(1): 233-239. DOI:10.1183/09031936.00011313.
[15]中国医师协会呼吸医师分会病理工作委员会. 非特异性间质性肺炎病理诊断中国专家共识(草案)[J]. 中华结核和呼吸杂志, 2018, 41(11):833-839. DOI:10.3760/cma.j.issn.1001-0939.2018.11.001.
Respiratory Physician Branch Pathology Committee of Chinese Medical Doctor Association.Chinese expert consensus on the pathological diagnosis of non-specific interstitial pneumonia (draft)[J]. Chin J Tubere Respir Dis,  2018, 41(11):833-839. DOI:10.3760/cma.j.issn.1001-0939.2018.11.001.
[16]JOHANNSON K A, MARCOUX V S, RONKSLEY P E, et al. Diagnostic yield and complications of transbronchial lung cryobiopsy for interstitial lung disease: A systematic review and meta-analysis[J]. Ann Am Thorac Soc, 2016, 13(10): 1828-1838. DOI:10.1513/AnnalsATS.201606-461SR.
[17]American thoracic Society/European respiratory society. International multidisciplinary consensus classification of the idiopathic interstitial pneumonias[J]. Am J Respir Crit Care Med, 2002, 165(2): 277-304. DOI:10.1164/ajrccm.165.2.ats01.
[18]SRIPRASART T, ARAGAKI A, BENZAQUEN S. Safety and diagnostic yield of transbronchial cryobiopsy[J]. Eur Respir J, 2016,48: PA4667. DOI: 10.1183/13993003.congress-2016.PA4667.

更新日期/Last Update: 2019-09-09