王晓艳, 苏敏. 石棉肺的病理学-对诊断标准的更新——美国病理医师学会和肺部病理协会组建的国际石棉委员会的报告[J]. 环境与职业医学, 2012, 29(3): 175-182.
引用本文: 王晓艳, 苏敏. 石棉肺的病理学-对诊断标准的更新——美国病理医师学会和肺部病理协会组建的国际石棉委员会的报告[J]. 环境与职业医学, 2012, 29(3): 175-182.
WANG Xiao-yan , SU Min . Pathology of Asbestosis-An Update of the Diagnostic Criteria: Report of the Asbestosis Committee of the College of American Pathologists and Pulmonary Pathology Society[J]. Journal of Environmental and Occupational Medicine, 2012, 29(3): 175-182.
Citation: WANG Xiao-yan , SU Min . Pathology of Asbestosis-An Update of the Diagnostic Criteria: Report of the Asbestosis Committee of the College of American Pathologists and Pulmonary Pathology Society[J]. Journal of Environmental and Occupational Medicine, 2012, 29(3): 175-182.

石棉肺的病理学-对诊断标准的更新——美国病理医师学会和肺部病理协会组建的国际石棉委员会的报告

Pathology of Asbestosis-An Update of the Diagnostic Criteria: Report of the Asbestosis Committee of the College of American Pathologists and Pulmonary Pathology Society

  • 摘要: 石棉肺是由于过量吸入石棉纤维而导致的肺弥漫性纤维化病变。其病理特征为特定型肺纤维化伴随肺内多量石棉沉着的表现,临床上疾病发展较慢,从开始接尘到出现症状,典型的潜伏期可长达20年以上。本文重点摘译介绍美国病理医师学会和肺部病理协会所组建的国际石棉委员会于2010年制定的"新石棉肺病理诊断标准"(以下简称"新标准"),主要从历史背景、石棉矿物学、石棉肺的诊断三个方面进行阐述,该"新标准"最重要的更新点为石棉小体的作用和石棉纤维分析的作用。(1)石棉小体的作用:肺泡腔内或者纤维灶中出现石棉小体在组织学上被认为是石棉吸入的证据。石棉小体与其他含铁小体的区别之处为石棉小体相对较细且具有半透明的轴心。在5 μm厚的常规切片中,石棉小体数如果≥2个/cm2,同时伴有特定类型的肺纤维化时,就可以确诊为石棉肺。当石棉小体数量很少时也不能直接排除石棉肺的诊断,而是需要对肺消化物进行石棉纤维的定量分析。(2)石棉纤维分析的作用:用于石棉纤维定量分析的材料,通常为肺消化物或者支气管肺泡灌洗液。用来观察的工具常为光学显微镜、扫描电镜或者透射电镜。然而无论使用何种技术,其结果的准确性都取决于各个实验室对技术的选择和结果分析等的熟练程度。测量结果必须和该实验室制定的参考范围作比较。不仅如此,石棉肺还需要与其它肺纤维化疾病相鉴别,尤其是需要与特发性肺纤维化及呼吸性细支气管炎相鉴别。与特发性肺纤维化相鉴别,石棉肺与特发性肺纤维化均表现为胸膜基底部的间质性纤维化,其鉴别之处有三:一是石棉肺纤维化几乎不伴感染,而特发性肺纤维化则与之相反;二是石棉肺疾病发展速度较慢,极少出现成纤维细胞,而特发性肺纤维化却以成纤维细胞灶为特征;三是石棉肺通常伴有脏层胸膜的轻度纤维化,而此现象在特发性肺纤维化中则较少见。与呼吸性细支气管炎相鉴别:石棉肺病灶常始于呼吸性细支气管附近,逐渐向外扩展并侵及周围越来越多的肺腺泡,直至这些独立的纤维灶相连,形成典型的弥漫性纤维化病变,尽管疾病早期很难与吸烟者及混合粉尘性尘肺患者所发生的腺泡中央型肺纤维化相区别,但是,其与呼吸性细支气管炎的鉴别点是石棉肺的纤维化不会局限于细支气管壁。

     

    Abstract: Asbestosis is defined as diffuse pulmonary fibrosis caused by the inhalation of excessive amounts of asbestos fibers. The report proposed a new grading scheme by the College of American Pathologists and the National Institute for Occupational Safety and Health Asbestos Committee in 2010. The updates focused on asbestosis pathological diagnosis and differential diagnosis from other pulmonary fibrotic disorders. Pathological diagnosis criteria of asbestosis:there is an acceptable pattern of alveolar septal fibrosis and an average rate of asbestos bodies of at least 2/cm2 of lung. Differential diagnosis:asbestosis should be distinguished from lung diseases associated with silicosis, mixed-dust pneumoconiosis, cigarette smoking and idiopathic pulmonary fibrosis. The aim of this new edition is to define the morphologic features of asbestosis at its various stages, relate exposure levels to specific tissue reactions, and evaluate the grading scheme published in the first report. These guidelines primarily focus on pathologic diagnosis, but clinical, radiologic presentations and epidemiology are also included. Techniques for the assessment of asbestos fiber burden are also evaluated.

     

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