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目的探讨肺结节病的病理和影像学特征,提高临床诊断水平。方法回顾性分析2000年1月至2005年8月在北京协和医院住院的46例肺结节病患者的病理和影像学资料。结果46例肺内结节病患者支气管肺泡灌洗液中淋巴细胞为0.47±0.18,CD_4/CD_8为6.63±4.51,血清血管紧张素转化酶(ACE)水平为(47±16)U/L。12例胸部 CT 表现为纵隔肺门淋巴结对称性肿大。16例表现为肺内结节影,沿支气管纹理分布或散在随机分布,旱粟粒状。多发斑片状(实变影)为13例。双肺磨玻璃样变为5例;13例经开胸、胸腔镜和纵隔镜取病理,33例行经皮肺活检、经支气管镜黏膜或肺活检。镜下可见病变内无干酪坏死上皮样结节。结节间可见无细胞成分的玻璃样变物质。结节围绕血管、淋巴管及支气管黏膜下分布,部分病例可见肉芽肿性血管炎。结论肺结节病胸部CT 表现多样,确诊需要临床、支气管肺泡灌洗液检测结果和病理学表现并结合糖皮质激素疗效综合判断。
Objective To investigate the pathological and imaging features of pulmonary sarcoidosis and to improve the clinical diagnosis. Methods The clinical data of 46 patients with pulmonary sarcoidosis who were hospitalized in Peking Union Medical College Hospital from January 2000 to August 2005 were analyzed retrospectively. Results The number of lymphocytes in bronchoalveolar lavage fluid of 46 patients with pulmonary sarcoidosis was 0.47 ± 0.18, the CD_4 / CD_8 was 6.63 ± 4.51 and the level of serum angiotensin converting enzyme (ACE) was (47 ± 16) U / L. Twelve cases of chest CT showed mediastinal hilar lymph node symmetry enlargement. 16 cases showed pulmonary nodules, along the distribution of bronchial or scattered randomly distributed, dry millet-like. Multiple patchy (consolidation of real) for 13 cases. Five lung biopsies were obtained in both lungs; 13 underwent thoracotomy, thoracoscopy and mediastinoscopy; 33 underwent percutaneous biopsy; bronchial mucosa or lung biopsy. Lesions visible within the microscope no cheese necrosis epithelioid nodules. Nodular visible cell-free components of the glass-like material. Nodules around the blood vessels, lymphatic and bronchial submucosal distribution, some cases of granulomatous vasculitis. Conclusions CT findings of pulmonary sarcoidosis in the chest are various. Diagnosis, bronchial alveolar lavage fluid test results and pathological findings are required for the diagnosis, combined with the comprehensive evaluation of the effect of glucocorticoid.