目的:研究支气管色素沉着纤维化(BAF)患者的临床特征.方法:选取经电子支气管镜检查确诊的支气管色素沉着纤维化病例70例,回顾性分析、总结其肺部高分辨CT、支气管镜镜检、刷检细胞学及活检病理等改变.其中有53例进行了肺功能检查,将其设为实验组,另随机抽取53例非BAF患者为对照组行肺功能检查,比较2组间第1秒钟用力呼气量(FEV1%)、用力肺活量(FVC%)、第1秒率(FEV1/FVC%)的不同.结果:支气管镜镜检示管腔扭曲、变形20例,闭塞20例,裂隙样狭窄17例,环形狭窄3例;管腔黏膜类肿瘤样增生3例,肥厚、水肿39例,肉芽肿样改变2例,丘状隆起8例,瘢痕样改变8例、坏死物5例,干酪样坏死物7例;管腔狭窄:左主支气管2例,右主支气管1例;左肺上叶支气管(8例),右肺中叶支气管(22例)及上叶支气管(14例);左、右肺上叶尖后段支气管狭窄多见;其中多叶段管腔狭窄16例.肺部高分辩CT(HRCT):肺间质改变15例,胸腔积液12例,胸膜增厚、粘连10例.肺结核25例,右肺中叶不张27例,右肺上叶不张5例,左肺上叶狭窄并肺不张18例,右肺下叶肺不张2例,左肺上叶上支狭窄1例,增殖、纤维化改变38例,肺部小结节影12例,陈旧性肺结核9例,斑片状阴影4例;纵膈淋巴结增大并钙化20例,肺门淋巴结增大并钙化10例,肺门淋巴结增大10例;BAF组FEV1%、FVC%、FEV1/FVC%均低于正常参考值;BAF组FEV1%、FVC%、FEV1/FVC%均低于非BAF组(P<0.01或P<0.05).慢性黏膜炎20例,玻璃样变2例,尘细胞沉积1例,碳末沉积3例,纤维素渗出4例,间质纤维组织增生4例,干酪样坏死4例,局灶上皮鳞化3例,淀粉样变性1例;T-spot T.B试验阳性20例,PPD试验阳性16例.结论:BAF的支气管镜镜检、病理改变、肺部高分辨CT、肺功能都具有一定特征性改变,与肺结核、慢性阻塞性肺疾病有相关性.%Objective: To study the clinical characteristics of bronchial anthracofibrosis (BAF).Methods: Seventy cases who were definitely diagnosed as having BAF by bronchovideoscope in our hospital were selected, and the changes in pulmonary high resolution computerized tomography (HRCT), bronchoscopy, brush cytology and biopsy, etc.were retrospectively analyzed.Of these patients above-mentioned, 53 cases were subjected to the pulmonary function test and served as the experimental group.In addition, 53 cases of non-BAF were randomly selected for pulmonary function test also, and served as the control group.The FEV1%, FVC% and FEV1/FVC% between the two groups were compared.Results: Bronchoscopy showed distortion and deformation of lumens in 20 cases, occlusion in 20 cases, slit like stenosis in 17 cases and annular stenosis in 3 cases;tumor-like hyperplasia in 3 cases, hypertrophy and edema in 39 cases, granulomatous variations in 2 cases, hill like eminentia in 8 cases, ouloid variations in 8 cases, sphacelus in 5 cases and caseous materials in 7 cases;luminal stenosis of left and right principal bronchi in 2 cases and 1 case, luminal stenosis of lobar bronchi in superior lobe and middle lobe of left lung in 8 cases and 22 cases and in superior lobe of right lung in 14 cases;the segmental bronchi stenosis seen mostly in posterior segments of the superior lobes of left lung and right lung, among which 16 cases had multilobar segmental stenosis.HRCT showed there were 15 cases of interstitial variations, 12 cases of pleural effusion, 10 cases of pleural thickness and adhesion, 25 cases of tuberculosis, 27 cases of atelectasis in middle lobe of right lung, 5 cases of atelectasis in superior lobe of right lung, 18 cases of stenosis and atelectasis in superior lobe of left lung, 2 cases of etelectasis in inferior lobe of right lung.1 case of stenosis in superior branch of superior lobe of left lung, 38 cases of proliferation and fibrosis, 12 cases of pulmonary nodular shadows, 9 cases of obsolete pulmonary tuberculosis and 4 cases of patchy shadows, 20 cases of enlargement and calcification in mediastinal lymph nodes, 10 cases of enlargement and calcification in hilar lymph nodes and 10 cases of enlargement in hilar lymph nodes.FEV1/FVC%, FEV1% and FVC% in BAF group were below the normal reference.FEV1%, FVC% and FEV1/FVC% in BAF group were significantly lower than those in non-BAF group (P<0.01 or P<0.05).Pathologic changes demonstrated 20 cases of chronic mucositis, 2 cases of hyaline changes, 1 case of sedimentation of dust cells, 3 cases of anthracosis, 4 cases of fibrin exudation, 4 cases of hyperplasia of interstitial fibrous tissues, 4 cases of caseous necrosis, 3 cases of focal epithelial squamous metaplasia and 1 case of amyloidosis.There were 20 cases of positive results of T-spot T.B test, and 16 cases of positive results of PPD test.Conclusion: There are some certain characteristic changes in pulmonary HRCT, bronchoscopy and pathologic changes of BAF, which relates to tuberculosis and chronic obstructive pulmonary diseases.
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