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目的 :探讨弥漫性肺疾病支气管肺泡灌洗液 (BALF)检查的临床意义。方法 :71例X线胸片或高分辨CT示弥漫性肺疾病者进行支气管肺泡灌洗 (BAL) ,与 12例胸片和肺功能均正常者作对照。BALF进行细胞计数、分类 ,查找癌细胞、结核菌 ,部分标本测定T淋巴细胞亚群。结果 :结核组BALF病因诊断率 46 .7% ,高于经支气管肺活检 (TBLB ,16 .7% )和支刷(33.5 % ) ;肺癌组BALF与TBLB确诊率相同 (46 .2 % ) ,高于支刷 (2 3.1% ) ,BALF细胞学显示 :(1)肺癌组呈Lyc %下降 ,Neu %增高 ,CD4+ %下降 ,CD8+ %增高 ,CD4+ /CD8+ 比值 <1;(2 )致纤维化肺泡炎 (IPF)BALF呈中性粒细胞肺泡炎 (Neu达2 4.89± 2 1.42 % ) ;(3)过敏性肺泡炎 (HP)呈淋巴细胞肺泡炎〔Lyc达 (19.40± 3.2 4) %〕 ;(4)结缔组织病合并肺泡炎 (CP)BALFLyc%和Neu %均增高 (P <0 .0 1)。结论 :BALF检查对弥漫肺的诊断、鉴别诊断、临床分型、判断预后及探明肺局部免疫病理生理变化均有帮助。
Objective: To investigate the clinical significance of bronchoalveolar lavage fluid (BALF) in diffuse pulmonary disease. Methods: Bronchial alveolar lavage (BAL) was performed in 71 patients with diffuse lung disease on chest X-ray or high resolution CT, which was compared with 12 patients with normal chest and lung function. BALF count, classification, find cancer cells, Mycobacterium tuberculosis, T lymphocyte subsets were measured in some specimens. Results: The diagnosis rate of BALF in tuberculosis group was 46.7%, higher than those in bronchogenic lung biopsy (BRT, 16.7%) and bronchial brushing (33.5%). The diagnosis rate of BALF and TBLB was the same in lung cancer group (46.2%), BALF cytology showed: (1) Lyc% decreased, Neu% increased, CD4 +% decreased, CD8 +% increased, CD4 + / CD8 + ratio <1 in lung cancer group; (3) Allergic alveolitis (HP) showed lymphocytic alveolitis [Lyc up to (19.40 ± 3.2 4)%]), alveolar inflammation (IPF) BALF was neutrophilic alveolitis (Neu up to 4.89 ± 2.142% ; (4) Connective tissue disease with alveolitis (CP) BALFLyc% and Neu% were increased (P <0.01). Conclusions: The diagnosis of BALF in BALF is helpful for the diagnosis, differential diagnosis, clinical classification, prognosis and pathophysiological changes of lung in BALF.