Schnabel A, Holl-Ulrich K, Dalhoff K, Reuter M, Gross W L
Poliklinik für Rheumatologie, Medizinische Universität Lübeck, Rheumaklinik Bad Bramstedt, Germany.
Eur Respir J. 1997 Dec;10(12):2738-43. doi: 10.1183/09031936.97.10122738.
This study was performed to determine the value of transbronchial biopsy (TBB) in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides and mild-to-moderate pulmonary involvement. Included in the study were 19 patients with Wegener's granulomatosis (WG) and six patients with Churg-Strauss syndrome (CSS) with evidence of active pulmonary disease but without gross parenchymal lesions accessible by radiologically guided biopsy. All of the patients had undergone staging examinations which included TBB taken from peripheral lung tissue and from any focal tracheobronchial lesions. Any suspicious lesion in the upper respiratory tract was biopsied by an otolaryngologist and the number of positive biopsies was compared with that of TBB. In the WG patients, only two out of 17 biopsies of alveolar tissue yielded histopathological findings supporting the diagnosis of WG. In five WG patients, ulcerative or exophytic airway lesions were found whose histopathologies were invariably positive. Otolaryngological examination revealed abnormal findings in 19 WG patients and biopsies from these sites yielded positive results in 13 instances. In CSS, TBB produced a diagnostically helpful histopathology in four of six cases and biopsies from the upper respiratory tract were positive in five out of six cases. We conclude that transbronchial biopsies of alveolar tissue are seldom positive in Wegener's granulomatosis patients with mild-to-moderate pulmonary disease unless they are taken from grossly abnormal lung areas. Conversely, ulcerative, exophytic or stenotic tracheobronchial lesions had a high rate of positive findings. These results further suggest that the upper rather than the lower respiratory tract should be the biopsy site of first choice in Wegener's granulomatosis. In Churg-Strauss syndrome, the upper and lower respiratory tract seem to yield a roughly equal number of positive biopsies.
本研究旨在确定经支气管活检（TBB）在抗中性粒细胞胞浆抗体（ANCA）相关血管炎且有轻至中度肺部受累患者中的价值。研究纳入了19例韦格纳肉芽肿（WG）患者和6例变应性肉芽肿性血管炎（CSS）患者，这些患者有活动性肺部疾病的证据，但无放射学引导活检可及的明显实质病变。所有患者均接受了分期检查，包括从外周肺组织和任何局灶性气管支气管病变处获取TBB。上呼吸道的任何可疑病变均由耳鼻喉科医生进行活检，并将阳性活检数量与TBB的阳性数量进行比较。在WG患者中，17例肺泡组织活检中仅有2例产生了支持WG诊断的组织病理学结果。在5例WG患者中，发现了溃疡性或外生性气道病变，其组织病理学结果均为阳性。耳鼻喉科检查显示19例WG患者有异常发现，其中13例这些部位的活检结果为阳性。在CSS患者中，6例中有4例TBB产生了有助于诊断的组织病理学结果，6例中有5例上呼吸道活检结果为阳性。我们得出结论，在患有轻至中度肺部疾病的韦格纳肉芽肿患者中，除非从明显异常的肺区域取材，否则肺泡组织的经支气管活检很少呈阳性。相反，溃疡性、外生性或狭窄性气管支气管病变的阳性发现率很高。这些结果进一步表明，在韦格纳肉芽肿中，上呼吸道而非下呼吸道应作为首选活检部位。在变应性肉芽肿性血管炎中，上呼吸道和下呼吸道产生阳性活检的数量似乎大致相等。
