| Research BackgroundPulmonary disease is a type of disease that seriously harms men's health. According to the statistical data of the ten major death-causing diseases in some cities and rural areas in China in 2001, respiratory system disease (except for lung cancer) is the fourth major cause of death in cities(13.36%), the first major cause of death in rural areas (22.46%), and the first major cause of death in the country. The inhalation of rationalized and biological agents, resulting from the air pollution, smoking and industrialization, and the aging of population have increased the disease incidence of pulmonary diseases, such as lung cancer, bronchial asthma, and chronic obstructive pulmonary diseases in recent years. The fact that the disease incidence of tuberculosis, pulmonary diffuse interstitial fibrosis and immunocompromised pulmonary infectious disease has picked up proves the arduousness of the task of prevention and treatment. A number of pulmonary diseases can be diagnosed according to the patient's medical history, physical signs, images and laboratory examinations, etc. However, due to the great variety of pulmonary diseases, many a disease cannot be correctly diagnosed merely through medical history, physical signs, x-ray pulmonary images, pulmonary CT and laboratory examinations. In clinical practice, lung biopsy is usually necessary. Transbronchial lung biopsy is the most commonly used biopsy. Since 1970s, as the development of transbronchoscope, TBLB has been widely used in the diagnosis of pulmonary diseases. Afterwards, the later continuous development of this technology has promoted great progress in the diagnosis and treatment of respiratory diseases. Nowadays, the technology has become a crucial method for the diagnosis and treatment of respiratory diseases. It is advantageous in the facts that it is easy to process, highly safe and it can be applied as a routine test. However, because the location and amount of biopsy tissues are limited, it cannot fully reflect the range and degree of pulmonary pathological changes, thus its value in the diagnosis of interstitial lung disease is questioned. According to studies in and abroad, there is a great disparity in the positive detection rate of pulmonary diseases through TBLB.This experiment further estimated the value of TBLB in the diagnosis of pulmonary diseases, by doing a retrospective analysis of the TBLB results of 4524 patients who were treated or hospitalized in the respiratory department of our hospital within the time span of July, 1993 to December, 2007. 322 cases of pathological sections diagnosed as interstitial pulmonary diseases through TBLB were checked again, in order to examine the diagnostic and classified diagnostic value of TBLB in interstitial pulmonary diseases. At the same time, the expressions and significance of different cytokines from the transbronchial lung biopsy tissues of 54 different types of idiopathic interstitial pneumonia patients were analyzed.Objectives1. To study and evaluate the diagnostic value of TBLB for respiratory system diseases, and to further examine the significance of TBLB in the diagnosis and classified diagnosis of interstitial pulmonary diseases.2. By analyzing the age and gender of TBLB patients, find out the new reference provided for the diagnosis and differential diagnosis of respiratory system diseases by the constituent ratios, the positive detection rates, and the clinical diagnostic accordance of different diseases.3. To estimate the value of TBLB for the diagnosis and classified diagnosis of interstitial pulmonary diseases.4. To study the distribution, expression and significance of TGFβ1,TNF-α,IL-1,PDGF,NF-κB in the transbronchial lung biopsy tissues of different tissue types of idiopathic interstitial pneumonias.Methods1. Collect the TBLB results of 4524 pulmonary disease patients who were treated or hospitalized in the respiratory department of our hospital within the time span of July, 1993 to December, 2007.2. Input and process the data statistically with SAS8.02 standard database by Excel, according to the patients'gender, age, clinical records, pathological tissue diagnosis and year of TBLB tests.3. Obtain lung tissues of 54 idiopathic interstitial pneumonia patients through TBLB. Do semiquantitative analysis of the distribution and expression of cytokines by immunohistochemical methods.Results1.The accordance rate between the clinical diagnosis and pathologic diagnosis of four major diseases (lung tumour,tuberculosis,interstitial pulmonary disease,acute and chronicity pneumonia) is evidently low(P<0.01). The accordance rate of interstitial pulmonary disease is 84.37%, being the highest, that of lung tumour is 75.6%, being the second highest, and that of acute and chronicity pneumonia is 71.84% and that of tuberculosis is 45.66%. The accordance rate of male lung tumour patients is higher than that of female ones(P<0.01) . The accordance rate of female tuberculosis patients is higher than that of male ones(P<0.01) .2. A comparison between the elderly group and non-elderly group in a corresponding time period: as to lung cancer and interstitial pulmonary disease, the detection rate of the elderly group is higher than that of the non-elderly group(P<0.01). As to tuberculosis and acute and chronic non-specific pneumonia, the detection rate of the elderly group is lower than that of the non-elderly group(P<0.01). And in the comparison between the classified detection rates of lung cancer of the two groups, the squamous carcinoma detection rate of the elderly group is higher than that of the non-elderly group ( P < 0.01 ) . As to small cell cancer and undetermined cancer, the detection rate of the non-elderly group is higher than that of the elderly group(P<0.01, P<0.05).3. The detection rate of male lung carcinoma patients is higher than that of female ones(P<0.01), however, the detection rate of female interstitial pulmonary disease and tuberculosis patients is higher than that of male ones(P<0.01). The detection rate of male squamous carcinoma patients is higher than that of female ones(P<0.01). The detection rate of female adenocarcinoma and small cell cancer patients is higher than that of male ones(P<0.01).The average ages of different types of lung cancer are significantly different (P<0.0001). The average age of squamous carcinoma patients is higher than that of adenocarcinoma and small cell cancer ones.4. The idiopathic interstitial pneumonia is higher than pulmonary nodules(P<0.05), but its inconsistence with the ILD in relation to connective tissues is minor(P>0.05). In IIPs,the age of pothogenesy of UIP is higher than that of NSIP,LIP,COP and AIP(P<0.05). NSIP is higher than LIP,DIP and LIP(P<0.05).The proportion of the elderly of UIP is high, however, NSIP,LIP,COP are mostly non-elderly(P<0.05).5. In the TBLB tissues of different types of idiopathic interstitial pneumonia, the expressive intensity of five cytokines(TGF-β1,TNF-α,IL-1,PDGF,NF-κB)is evidently stronger than normal comparative groups(P<0.05), the expressive intensity of different types is evidently different (P<0.05).Conclusion1.TBLB pathology test has basically proved the epidemic status of present respiratory system diseases. It is the vital standard for diagnosing pulmonary diseases and it has a relatively higher diagnostic and differential diagnostic value especially for cases that can not be diagnosed by routine examinations, high resolution CT scans, etc. TBLB pathology test has raised the diagnostic and differential diagnostic level of interstitial pulmonary disease, lung tumour and tuberculosis, and at the same time reduced the rate of misdiagnosis and mistreatment.2. Gender and age is related to the outburst and development of lung cancer. Elderly male is the high-risk group of lung cancer; elderly people are at a high risk of getting squamous carcinoma, while small cell carcinoma is common among middle aged people; the detection rate of male squamous carcinoma is higher than that of female; the detection rate of female adenocarcinoma and small cell carcinoma is higher than that of male.3. The pathological results proved the pothogenesy status of 322 cases of ILD, the prevalence rate is 279 cases of IIP (86.65%) as the first, 11 cases of ILD related to connective tissue diseases (3.42%) as the second, and 8 cases of sarcoidosis(2.48%)as the third; in IIP the prevalence rate of NSIP is the highest being 133 cases (47.67%), next comes UIP being 95 cases (34.05%), both NSIP and UIP are common types of IIP. UIP is common among the elderly group (older than 60); the average morbidity age of NSIP, DIP, RBILD, COP is between 50 and 59; the average morbidity age of LIP and AIP is below 50.4. TBLB is an effective means to diagnose interstitial pulmonary disease, and it has a great significance for the differential diagnosis and classified diagnosis of interstitial diseases. In the diagnosis of interstitial diseases tissues should be obtained from different parts with pathological changes for several times, and sometimes TBLB needs to be done repeatedly when necessary. 5. In the TBLB pathological diagnosis of UIP, seldom can honeycomb lung tissues be obtained. As a result, the focal observation of the change is the mixed distributions of light and heavy, old and new pathological changes. Some normal lung tissues can be observed among pathologically changed tissues. The changes of honeycomb lung could consult the iconographical changes. Other types of idiopathic interstitial pneumonia can be diagnosed by obtaining lung tissues from areas with pathological changes.6. The expression level of TGF-β1 can be regarded as a screening test method for IIP types. By consulting medical history and morbidity age, it is good for the diagnosis of UIP and AIP; TNF-αmight have participated in the outburst and development process of most cases of IIP, and it can be considered as an initial selection indication, by consulting the expression of other factors, it is good for the diagnosis of IIP; TNF-αis related to the factor at the early stage of lung fibrosis, but there is no significance when the fibrosis is complete; the expression of IL-1 is the highest among the AIP group, and is greatly significant for the diagnosis; the expression of PDGF in different types of IIP lung tissues is higher than that of healthy lung tissues, and can be regarded as an initial selection indication of IIP; NF-κB might affect the outburst and development of IIP by promoting or activating the activity of previously mentioned cell factors. At the same time NF-κB is also a necessary transcription factor in healthy histiocyte. |
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