CAJ | 학술논문

目的：探讨外源性变应性肺泡炎（ extrinsic allergic alveolitis，EAA）的临床特点及诊疗思路。方法回顾分析1例吸入异氰酸酯所致 EAA的诊治经过，并复习相关文献。结果患者表现为反复咳嗽、发热及活动后气促。外院胸部高分辨率 CT（ HRCT）检查示双肺弥漫性间质病变，诊断为间质性肺炎，予相应治疗病情无好转。入我科后追问病史，发现有异氰酸酯吸入史。支气管肺泡灌洗液（ BALF）细胞分类淋巴细胞增多。转胸外科行右下肺楔形切除术，术后病理检查确诊 EAA。予甲泼尼龙治疗14个月，临床症状及胸部 HRCT 表现均得到明显改善。结论胸部HRCT检查对 EAA的诊断和鉴别诊断有较大价值，肺活组织病理检查是其确诊手段。随着工业发展，临床医师应警惕吸入异氰酸酯等小分子化合物所致 EAA。
목적：탐토외원성변응성폐포염（ extrinsic allergic alveolitis，EAA）적림상특점급진료사로。방법회고분석1례흡입이청산지소치 EAA적진치경과，병복습상관문헌。결과환자표현위반복해수、발열급활동후기촉。외원흉부고분변솔 CT（ HRCT）검사시쌍폐미만성간질병변，진단위간질성폐염，여상응치료병정무호전。입아과후추문병사，발현유이청산지흡입사。지기관폐포관세액（ BALF）세포분류림파세포증다。전흉외과행우하폐설형절제술，술후병리검사학진 EAA。여갑발니룡치료14개월，림상증상급흉부 HRCT 표현균득도명현개선。결론흉부HRCT검사대 EAA적진단화감별진단유교대개치，폐활조직병리검사시기학진수단。수착공업발전，림상의사응경척흡입이청산지등소분자화합물소치 EAA。
Objective To explore the clinical features and treatment of extrinsic allergic alveolitis( EAA). Methods The diagnosis and treatment of one patient with EAA induced by isocyanate suction was reviewed,and the relevant literature was also reviewed. Results The patient suffered chronic cough,fever and accelerated breathing after activities. In other hos-pitals,the chest high-resolution computed tomography( HRCT)showed diffuse interstitial substance pathological changes in hibateral pulmones,and the patient was diagnosed as having interstitial pneumonia,but the patient′s condition did not improve after corresponding treatment. In our department,the patient was found to have a history of isocyanate suction after history en-quiry. Lymphocytosis was found after bronchoalveolar lavage fluid(BALF)cell classification. After the thoracic surgery,right pulmonary wedge resection was performed,and then the diagnosis of EAA was confirmed by postoperative pathological exami-nation. The patient′s manifestations and chest HRCT symptoms significantly improved after methylprednisolone therapy for four-teen months. Conclusion Chest high resolution computed tomography( HRCT)has great value in diagnosis and differential diagnosis of EAA. Pathologic examination of pulmonary living tissue can be used to confirm the diagnosis. With developing in-dustry,clinicians should be alert to EAA induced by suction of small molecular compounds such as isocyanate.