CAJ | 학술논문

目的探讨慢性嗜酸粒细胞性肺炎(chronic eosinophilic pneumonia,CEP)的临床特点、诊断及治疗,以提高早期诊治水平.方法回顾性分析2005年8月至2012年4月在解放军总医院住院的经病理确诊的5例CEP患者的临床诊治资料并结合文献复习加以总结.结果 5例患者均为女性,平均年龄(49.0±9.1)岁.主要症状为咳嗽(5/5)、咳痰(5/5)、呼吸困难(2/5)、发热(2/5)、疲劳乏力(2/5)、咯血(1/5)和体质量下降(1/5).主要体征为肺部湿哕音(2/5)和哮鸣音(1/5).5例外周血嗜酸粒细胞百分比为1％～26.3％,中位数为12.8％.4例外周血清总IgE为20.1～3 440.0 IU/ml,中位数为1 046.0 IU/ml.5例胸部CT主要表现为以外周为主的肺斑片状实变阴影(5/5).5例病理表现主要为肺泡腔及间质内以嗜酸粒细胞为主的炎症细胞浸润.5例出现症状至确诊时间平均为(7.6±6.6)个月,在确诊CEP前,曾被误诊为细菌性肺炎(4/5)、肺结核(3/5)、肺不张(2/5)、变态反应性支气管肺曲霉病(1/5)和肺癌(1/5).4例患者接受糖皮质激素(简称激素)治疗.随访3例患者,治疗后所有患者症状明显好转且胸部CT实变影病变范围减小；其中2例停药后出现复发,复发后再用激素治疗仍有效.结论 CEP起病隐匿,误诊率高.如果患者咳嗽、发热、呼吸困难持续2周以上,外周血和(或)支气管肺泡灌洗液嗜酸粒细胞数明显升高,胸部影像学表现为以肺外周为主的斑片状实变阴影,经抗生素治疗效果差,应考虑CEP可能.激素对CEP治疗效果良好,但早期停药容易复发.
목적 탐토만성기산립세포성폐염(chronic eosinophilic pneumonia,CEP)적림상특점、진단급치료,이제고조기진치수평.방법 회고성분석2005년8월지2012년4월재해방군총의원주원적경병리학진적5례CEP환자적림상진치자료병결합문헌복습가이총결.결과 5례환자균위녀성,평균년령(49.0±9.1)세.주요증상위해수(5/5)、해담(5/5)、호흡곤난(2/5)、발열(2/5)、피로핍력(2/5)、각혈(1/5)화체질량하강(1/5).주요체정위폐부습홰음(2/5)화효명음(1/5).5예외주혈기산립세포백분비위1％～26.3％,중위수위12.8％.4예외주혈청총IgE위20.1～3 440.0 IU/ml,중위수위1 046.0 IU/ml.5례흉부CT주요표현위이외주위주적폐반편상실변음영(5/5).5례병리표현주요위폐포강급간질내이기산립세포위주적염증세포침윤.5례출현증상지학진시간평균위(7.6±6.6)개월,재학진CEP전,증피오진위세균성폐염(4/5)、폐결핵(3/5)、폐불장(2/5)、변태반응성지기관폐곡매병(1/5)화폐암(1/5).4례환자접수당피질격소(간칭격소)치료.수방3례환자,치료후소유환자증상명현호전차흉부CT실변영병변범위감소；기중2례정약후출현복발,복발후재용격소치료잉유효.결론 CEP기병은닉,오진솔고.여과환자해수、발열、호흡곤난지속2주이상,외주혈화(혹)지기관폐포관세액기산립세포수명현승고,흉부영상학표현위이폐외주위주적반편상실변음영,경항생소치료효과차,응고필CEP가능.격소대CEP치료효과량호,단조기정약용역복발.
Objective To analyze the clinical features,diagnosis,and treatment of chronic eosinophilic pneumonia (CEP).Methods The clinical data of five patients with biopsy-proven CEP from August 2005 to April 2012 in Chinese PLA general hospital were retrospectively analyzed,and the literatures were reviewed.Results The patients were all female,with mean age of (49.0 ± 9.1) years.The main clinical manifestations included cough (5/5),sputum production (5/5),dyspnea (2/5),fever (2/5),acratia (2/5),hemoptysis (1/5),and weight lost (1/5).The respiratory signs consisted of rales (2/5) and wheezes (1/5).In these cases,the percentage of peripheral blood eosinophil count was 1 ％～26.3％,with the median of 12.8％.The total serum IgE level of four patients was 20.1～3 440.0 IU/ml,with the median of 1 046.0 IU/ml.The chest CT scan mainly demonstrated patchy consolidation with peripheral predominance (5/5).The pulmonary histological examination showed alveolar and interstitial inflammation with predominance of eosinophils.The interval from onset of symptoms to diagnosis was (7.6±6.6) months.Before the diagnosis of CEP,they had been misdiagnosed as bacterial pneumonia (4/5),tuberculosis (3/5),atelectasis (2/5),allergic bronchopulmonary aspergillosis (1/5),and lung cancer (1/5).Four patients were treated with corticosteroids.In the follow-up of three patients,symptoms dramatically regressed,and the consolidation opacities of CT scan were seen absorption.Two patients relapsed after stopping corticosteroid therapy,however,respond was very well on resumption of corticosteroid treatment.Conclusions The clinical manifestation of CEP is insidious,which makes it usually be misdiagnosed.CEP should be considered when a patient has a history of cough,fever,and dyspnea over two weeks,with presence of peripheral eosinophilia and (or) alveolar eosinophilia,and the characteristic chest radiographic appearance of peripheral infiltrates with consolidation opacities,especially when the treatment of antibiotics is not useful.Glucocorticoid has a dramatic effect in treatment of CEP,but relapse is often seen when corticoid therapy is stopped too early.