Shi Jin, Mao Ling, Zhou Shao-wei, Chen Zi-dan, Zhang Yue, Bian Lu-qin, Ma Guo-yun
Department of Pneumoconiosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2012 Apr;30(4):261-4.
To evaluate the role of transbronchial lung biopsy (TBLB) pathology in pneumoconiosis diagnosis.
During Jan 2003 to Jun 2010 in our hospital. 418 patients exposed to dusts were examined with TBLB. The chest radiographs of all subjects showed the pneumoconiosis-like opacities. Because the dust property or accumulated doses didn't match with abnormality on chest radiographs or there were no a series of chest radiographs, it was required for subjects to perform the TBLB for diagnosis. Three hundred seventy nine cases with satisfying samples served as the study subjects. The dust deposition, fibrosis and birefringent particles were found in TBLB pathological examinations. From May 2005, the Prussian blue iron reaction test was conducted on the TBLB samples. A panel made pneumoconiosis diagnosis according to GBZ 70-2002 and GBZ 70-2009 Pneumoconiosis Diagnostic Criteria, consulting subjects' accounts and pathologic results.
Among 379 subjects, 376 cases (99.2%) showed the lung interstitial fibrosis, 228 cases (60.2%) demonstrated the dust deposition, 111 cases (29.3%) expressed the birefringent particles by polarized light microscopy. Birefringent particles positive rate was 37.8% (62/164) in 164 patients exposed to either silica or potter dusts or cement dusts or coal-silica dusts or foundry dusts, which was much higher than that (22.7%, 49/215) in patients exposed to other dusts (welding fume or asbestos or aluminum dusts) (P < 0.05). The positive rate of Prussian blue iron reaction in 177 patients exposed to welding fume or burnishing dusts was 53.1% (94/177), which was significantly higher than that (23.2%, 13/56) in patients exposed to other dusts (cement dusts, casting dusts or silica) (P < 0.001). There were no significantly differences in rates of lung fibrosis, dust deposition and birefringent particles between pneumoconiosis and none-pneumoconiosis subjects. The rate of lung fibrosis in pneumoconiosis cases was significantly higher than that in non- pneumoconiosis cases (P < 0.05).
TBLB could provide the evidence of exposure to dusts and pathological changes, which may be useful to the pneumoconiosis diagnosis.
评估经支气管肺活检（TBLB）病理检查在尘肺病诊断中的作用。
2003年1月至2010年6月期间，我院对418例接触粉尘的患者进行了TBLB检查。所有受试者的胸部X线片均显示有尘肺病样阴影。由于粉尘性质或累积剂量与胸部X线片异常不相符或缺乏一系列胸部X线片，故要求受试者进行TBLB检查以明确诊断。379例样本满意的患者作为研究对象。TBLB病理检查发现有粉尘沉积、纤维化和双折射颗粒。2005年5月起，对TBLB样本进行普鲁士蓝铁反应试验。一个小组根据GBZ 70 - 2002和GBZ 70 - 2009《尘肺病诊断标准》，参考受试者的病史和病理结果做出尘肺病诊断。
379例受试者中，376例（99.2%）显示肺间质纤维化，228例（60.2%）有粉尘沉积，111例（29.3%）在偏振光显微镜下表现为双折射颗粒。164例接触二氧化硅、陶土粉尘、水泥粉尘、煤矽尘或铸造粉尘的患者中，双折射颗粒阳性率为37.8%（62/164），显著高于接触其他粉尘（焊接烟尘、石棉或铝粉尘）的患者（22.7%，49/215）（P < 0.05）。177例接触焊接烟尘或打磨粉尘的患者中，普鲁士蓝铁反应阳性率为53.1%（94/177），显著高于接触其他粉尘（水泥粉尘、铸造粉尘或二氧化硅）的患者（23.2%，13/56）（P < 0.001）。尘肺病患者与非尘肺病患者在肺纤维化、粉尘沉积和双折射颗粒发生率方面无显著差异。尘肺病患者的肺纤维化发生率显著高于非尘肺病患者（P < 0.05）。
TBLB可为接触粉尘及病理变化提供证据，可能有助于尘肺病的诊断。
