膠原病に伴う肺病変に対するTBLBの有用性に関する検討

抄録

In order to investigate the diagnostic value of transbronchial lung biopsy (TBLB) and the subsequent responsiveness to therapy, cases of collagen vascular disease with pulmonary involvement in which TBLB was performed between September 1977 and March 1989 were reviewed. The total number of cases was 38 including those of rheumatoid arthritis (17 cases), polymyositis (6 cases), dermatomyositis (1 case), progressive systemic sclerosis (6 cases), systemic lupus erythematosus (2 cases) and Sjögren's syndrome (6 cases).
TBLB was performed 45 times in these 38 cases, revealing positive findings in 34 cases (89. 5%), and in 39 of 45 procedures (86.7%). In 25 of 34 positive cases, prednisolone therapy was given, and 19 of 25 cases were effective. All cases of rheumatoid arthritis and Sjögren's syndrome with alveolitis revealed by TBLB were effective to prednisolone therapy. On the other hand, cases of polymyositis and progressive systemic sclerosis in which TBLB revealed alveolitis or bronchoalveolar lavage (BAL) showed elevation of the proportion of lymphocytes or polymorphonuclear cells were responsive to prednisolone therapy. Open lung biopsy was performed in only one case. The pathologic diagnosis in this case was pulmonary multiple nodular amyloidosis. Namely TBLB findings provide useful information in making the diagnosis of pulmonary involvement in cases of collagen vascular diseases and in evaluating the indication for steroid treatment.