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目的 探讨CT引导下经皮肺芯针切割活检术 (percutaneousCT-guidedcoreneedlebiopsy, PTCB)对活动性韦格纳肉芽肿(WG)的诊断价值以及指导临床治疗的意义。方法 8例经PTCB行病理组织学检查WG病人,根据其临床资料作BVAS评分,其结果与病理对照研究。结果 8例病人经PTCB取得足够的组织学标本,病理结果:①坏死性血管炎 ( 75% ),②肉芽性炎症(62. 5% ),③实质坏死 (50% ),④肺出血改变 (12. 5% ),⑤纤维化 (12. 5% )。确诊时BVAS平均分数为 10分,所有病人确诊后都进行了糖皮质激素联合细胞毒药物冲击治疗,临床有不同程度好转,治疗 4周后平均分数为 2. 5分。结论 多部位、多次经皮肺切割活检可以准确的诊断活动性WG,指导临床早期治疗。
Objective To investigate the diagnostic value of percutaneous CT-guided core needle biopsy (PTCB) for active Wegener’s granulomatosis (WG) guided by CT and its clinical significance. Methods Eight patients with WG were examined by pathological histology of PTCB. According to their clinical data, BVAS score was used and the results were compared with pathology. Results Eight patients had enough histological specimens after PTCB. The pathological findings included necrotizing vasculitis (75%), granulomatous inflammation (62.5%), substantial necrosis (50%), pulmonary hemorrhage ( 12.5%), ⑤ fibrosis (12.5%). The mean BVAS score at the time of diagnosis was 10 points, and all patients were treated with corticosteroid plus cytotoxic drugs after definite diagnosis. The clinics had varying degrees of improvement and the average score was 2.5 after 4 weeks of treatment. Conclusion Multi-site and multiple percutaneous lung biopsy can accurately diagnose active WG and guide clinical early treatment.