Department of Respiratory Medicine and Critical Care, Institute of Respiratory Medicine Beijing, Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Respiratory and Critical Care Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China.
Clin Respir J. 2023 Jan;17(1):50-58. doi: 10.1111/crj.13561. Epub 2022 Nov 17.
Hypersensitivity pneumonitis (HP) is a common type among all the interstitial lung diseases, and transbronchial lung cryobiopsy is an alternative diagnostic technique for interstitial lung diseases. In this study, we describe the clinical and pathological features of fibrotic hypersensitivity pneumonitis diagnosed with transbronchial lung cryobiopsy (TBLC).
A total of 46 diffused parenchyma lung disease (DPLD) patients received TBLC were included in this study. Medical records including medical history spirometry examinations, 6-min walk test (6MWT) results, high resolution computed tomographic (HRCT) scans, BAL, and histopathology were collected. Results of HRCT and histopathology were compared and classified, especially.
Sixteen patients were diagnosed with fibrotic HP, the mean age of whom was 56.3 ± 12.1 years, and 62.5% of them were male. Three of the 16 patients had been misdiagnosed as tuberculosis and received antituberculosis medications, five patients had been diagnosed as unclassifiable pulmonary fibrosis, and five patients had been diagnosed as idiopathic pulmonary fibrosis (IPF). Thirteen (81.3%) patients had a normal lymphocyte count in BAL. The pathological features of usual interstitial pneumonia (UIP) were detected in 11 (68.8%) of the cases, poor defined granulomatous was detected in nine (56.3%) of the cases, and bronchiolocentric fibrosis was detected in two (12.5%) of the 16 cases.
Fibrotic hypersensitivity pneumonitis should be included in differential diagnosis of pulmonary fibrosis. Pathological characteristics of fibrotic hypersensitivity pneumonitis could be demonstrated from cryobiopsy lung tissue. TBLC is recommended as an alternative diagnostic technique, which may improve the specificity of hypersensitivity pneumonia detection, and UIP is the most frequent pathological finding.
过敏性肺炎（HP）是所有间质性肺疾病中常见的一种类型，经支气管肺冷冻活检（TBLC）是间质性肺疾病的一种替代诊断技术。本研究描述了经支气管肺冷冻活检（TBLC）诊断的纤维化过敏性肺炎的临床和病理特征。
本研究共纳入 46 例弥漫性实质肺疾病（DPLD）患者接受 TBLC。收集了包括病史、肺功能检查、6 分钟步行试验（6MWT）结果、高分辨率计算机断层扫描（HRCT）扫描、支气管肺泡灌洗（BAL）和组织病理学在内的病历资料。比较并分类了 HRCT 和组织病理学结果，特别是。
16 例患者被诊断为纤维化 HP，平均年龄为 56.3±12.1 岁，其中 62.5%为男性。其中 3 例被误诊为肺结核并接受抗结核治疗，5 例被诊断为未分类的肺纤维化，5 例被诊断为特发性肺纤维化（IPF）。13 例（81.3%）患者 BAL 淋巴细胞计数正常。11 例（68.8%）患者存在普通间质性肺炎（UIP）的病理特征，9 例（56.3%）患者存在不明确的肉芽肿性病变，2 例（12.5%）患者存在细支气管中心性纤维化。
纤维化过敏性肺炎应纳入肺纤维化的鉴别诊断。冷冻活检肺组织可显示纤维化过敏性肺炎的病理特征。TBLC 被推荐作为一种替代诊断技术，它可以提高过敏性肺炎检测的特异性，UIP 是最常见的病理发现。
