支气管黏膜角化症1例并文献复习

Bronchial Mucosal Keratosis: A Case Report and Literature Review

摘要: 目的：通过支气管黏膜角化症病例报道及相关文献复习探讨该病的临床特点及治疗，提高临床医师对该病的诊疗水平。方法：该患者为23岁女性，于2021年4月21日入院，主要临床表现为咯血，胸部CT示右肺多发磨玻璃结节；纤维支气管镜下可见气管及隆突、右主支气管、右肺上叶可见广泛白色苔痂样覆盖；支气管镜下病理示：支气管黏膜鳞状上皮乳头状增生并表层过度角化，局部鳞状上皮呈轻度不典型增生；符合支气管黏膜角化症的诊断。结果：根据药敏试验结果给予比阿培南抗感染，氨溴索，雾化吸入布地奈德及吸入乙酰半胱氨酸化痰、舒张支气管等对症治疗，患者症状明显好转出院。随访1年，患者无咯血、咳嗽、咳痰等不适症状。结论：支气管黏膜角化症为少见病，缺乏特异性临床表现，目前诊断主要依靠纤维支气管镜及病理诊断，予以抗感染、化痰、舒张支气管等对症治疗，疗效较好。

Abstract: Objective: To explore the clinical characteristics and treatment of Bronchial Mucosal Keratosis by case report and related literature review, and to improve the level of diagnosis and treatment of bronchial mucosal keratosis by clinician. Methods: The patient was a 23-year-old female who was admitted to the hospital on April 21, 2021. The main clinical was hemoptysis, with multiple ground-glass nodules in the right lung on chest CT. The trachea and carina, the right main bronchus and the upper lobe of the right lung were all covered with white moss and scab. The pathological findings under bronchoscope were as follows: Chronic inflammation of bronchial mucosa with pa-pillary hyperplasia of squamous epithelium and hyperkeratosis of the superficial layer, and mild atypical hyperplasia of local squamous epithelium, which was consistent with the diagnosis of bronchial mucosal keratosis. Results: According to the results of the drug sensitivity test, the pa-tients were treated with Biapenem, Ambroxol, nebulized budesonide and inhaled acetylated L-cysteine to reduce sputum and dilate Bronchi. The patient’s symptoms improved significantly and were discharged. Follow-up for 1 year, the patient did not hemoptysis, cough, expectoration and other symptoms. Conclusion: Bronchial Mucosal Keratosis is a rare disease, which lacks specific clinical manifestations. At present, the diagnosis mainly depends on fiberoptic bronchoscopy and pathological diagnosis, and the symptomatic treatment such as anti-infection, resolving phlegm and relaxing bronchus has a good effect.