CAJ | 학술논문

目的分析干扰素所致间质性肺炎的临床、影像学和病理学特征及治疗.方法通过对1例干扰素α-2b治疗乙型肝炎导致间质性肺炎患者的临床、影像学及病理学及治疗转归分析,分别复习干扰素α治疗乙型肝炎和丙型肝炎导致间质性肺炎的相关文献,总结其特征.结果患者因慢性乙型肝炎单用重组人干扰素α-2b治疗5个月后出现咳嗽、进行性呼吸困难;体检肺部少许细湿啰音;血气分析示Ⅰ型呼吸衰竭.胸部CT示双肺多发磨玻璃影、网格状影.经纤维支气管镜肺活检组织病理显示急性肺泡损伤、间质纤维化.糖皮质激素治疗后,症状逐渐好转,随诊5个月病情相对稳定.检索国内外文献,未见有干扰素α治疗乙肝引起间质性肺炎的报道.把关键词乙型肝炎更换为丙型肝炎,则共检索到27例报道.主要症状是咳嗽(70.4%)、呼吸困难(77.8%)和发热(29.6%).出现症状的时间自用药后20 d至23周不等.除少数停药观察外,多数需要糖皮质激素治疗,死亡率为11.1%.结论干扰素治疗乙型肝炎时可能诱发急性间质性肺炎,临床医师应提高警惕.
목적 분석간우소소치간질성폐염적림상、영상학화병이학특정급치료.방법 통과대1례간우소α-2b치료을형간염도치간질성폐염환자적림상、영상학급병이학급치료전귀분석,분별복습간우소α치료을형간염화병형간염도치간질성폐염적상관문헌,총결기특정.결과 환자인만성을형간염단용중조인간우소α-2b치료5개월후출현해수、진행성호흡곤난;체검폐부소허세습라음;혈기분석시Ⅰ형호흡쇠갈.흉부CT시쌍폐다발마파리영、망격상영.경섬유지기관경폐활검조직병리현시급성폐포손상、간질섬유화.당피질격소치료후,증상축점호전,수진5개월병정상대은정.검색국내외문헌,미견유간우소α치료을간인기간질성폐염적보도.파관건사을형간염경환위병형간염,칙공검색도27례보도.주요증상시해수(70.4%)、호흡곤난(77.8%)화발열(29.6%).출현증상적시간자용약후20 d지23주불등.제소수정약관찰외,다수수요당피질격소치료,사망솔위11.1%.결론 간우소치료을형간염시가능유발급성간질성폐염,림상의사응제고경척.
Objective To analyze the clinical, radiological and pathological features and treatment of interstitial pneumonia induced by interferon. Methods The clinical, radiological and pathological features and treatment of a patient with interstitial pneumonia induced by interferon α-2b therapy for hepatitis B were analyzed, the related literatures of interstitial pneumonia caused by interferon α-2b therapy for hepatitis B and hepatitis C were reviewed, and the characteristics was summarized. Results A chronic hepatitis B patients had cough and progressive dyspnea after treatment with recombinant human interferon α-2b for five months. Physical examination showed a little moist rales in the lung. Blood gas analysis showed type I respiratory failure. Chest computerized tomography showed multiple lung ground glass, grid-like shadow. Lung biopsy pathology by bronchofibroscope showed acute alveolar damage, interstitial fibrosis. The symptoms of patient gradually improved after glucocorticoid treatment. Followed up for five months, the patient's condition was relative stable. There was no report about interstitial pneumonia caused by interferon a therapy for hepatitis B. Replacing the key word hepatitis B into hepatitis C, 27 cases reported were retrieved. The main symptoms were cough (70. 4%),dyspnea (77. 8%) and fever (29. 6%). Onset of symptoms of interstitial pneumonia ranged from 20 days to 23 weeks of therapy. Apart from a few withdrawal observation, most needed glucocorticoid treatment, and the mortality rate was 11. 1 %. Conclusions Acute interstitial pneumonia may be induced by interferon therapy for hepatitis B, and clinicians should have vigilance on it.