中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2013年
2期
83-87
,共5页
金贝贝%许文兵%彭敏%施举红%田欣伦%留永健%冯瑞娥%刘鸿瑞%蔡柏蔷%邵池%黄慧%柳涛%张弘
金貝貝%許文兵%彭敏%施舉紅%田訢倫%留永健%馮瑞娥%劉鴻瑞%蔡柏薔%邵池%黃慧%柳濤%張弘
금패패%허문병%팽민%시거홍%전흔륜%류영건%풍서아%류홍서%채백장%소지%황혜%류도%장홍
肺泡炎,外源变应性%回顾性研究%诊断
肺泡炎,外源變應性%迴顧性研究%診斷
폐포염,외원변응성%회고성연구%진단
Alveolitis,extrinsic allergic%Retrospective studies%Diagnosis
目的 提高对过敏性肺炎的认识及诊断水平.方法 回顾性分析2001年1月至2011年6月北京协和医院96例过敏性肺炎患者的临床资料,分为临床诊断组(49例)及病理诊断组(47例),从临床表现、实验室检查、致敏原、肺功能、胸部CT表现、BALF细胞学等方面进行综合分析.结果 96例患者中女58例(60.4％),中位年龄53岁；致敏原以小分子化学物质(42.7％)以及动物蛋白(37.5％)多见；常见临床表现为气短(90.6％)、咳嗽(76.0％)；肺功能以弥散功能障碍(73.5％)以及限制性通气功能障碍(59.7％)为主；影像学除表现为磨玻璃影(64.6％)、小叶中心性结节影(21.9％)、气体陷闭征(15.6％)外,还可见网格影(45.8％)、牵张性支气管扩张(21.9％)以及蜂窝肺(9.4％)表现；BALF细胞学淋巴细胞计数＞0.2以及CD4/CD8 ＜0.9的比例在病程＜1年的患者中更高；病理诊断组与临床诊断组比较,在年龄、性别分布以及临床表现、肺功能损害、影像学改变等方面具有较为一致的特点,但是病理诊断组病程更长(分别为24和6个月,Z=-2.492,P=0.013),杵状指趾(分别为23.4％和8.2％,x2=4.227,P=0.040)、弥散功能障碍(分别为90.7％和44.0％,x2=35.219,P＜0.01)以及网格、牵张性支气管扩张、蜂窝肺(分别为57.5％和26.5％,x2=9.434,P＜0.01)表现更加突出；经支气管镜肺活检诊断过敏性肺炎阳性率低(8.2％),病理确诊需外科肺活检.结论 过敏性肺炎诊断困难,部分病例可通过暴露病史、影像、BALF做出临床诊断,但是当上述表现不典型时,需借助病理进行临床-影像-病理综合诊断.
目的 提高對過敏性肺炎的認識及診斷水平.方法 迴顧性分析2001年1月至2011年6月北京協和醫院96例過敏性肺炎患者的臨床資料,分為臨床診斷組(49例)及病理診斷組(47例),從臨床錶現、實驗室檢查、緻敏原、肺功能、胸部CT錶現、BALF細胞學等方麵進行綜閤分析.結果 96例患者中女58例(60.4％),中位年齡53歲；緻敏原以小分子化學物質(42.7％)以及動物蛋白(37.5％)多見；常見臨床錶現為氣短(90.6％)、咳嗽(76.0％)；肺功能以瀰散功能障礙(73.5％)以及限製性通氣功能障礙(59.7％)為主；影像學除錶現為磨玻璃影(64.6％)、小葉中心性結節影(21.9％)、氣體陷閉徵(15.6％)外,還可見網格影(45.8％)、牽張性支氣管擴張(21.9％)以及蜂窩肺(9.4％)錶現；BALF細胞學淋巴細胞計數＞0.2以及CD4/CD8 ＜0.9的比例在病程＜1年的患者中更高；病理診斷組與臨床診斷組比較,在年齡、性彆分佈以及臨床錶現、肺功能損害、影像學改變等方麵具有較為一緻的特點,但是病理診斷組病程更長(分彆為24和6箇月,Z=-2.492,P=0.013),杵狀指趾(分彆為23.4％和8.2％,x2=4.227,P=0.040)、瀰散功能障礙(分彆為90.7％和44.0％,x2=35.219,P＜0.01)以及網格、牽張性支氣管擴張、蜂窩肺(分彆為57.5％和26.5％,x2=9.434,P＜0.01)錶現更加突齣；經支氣管鏡肺活檢診斷過敏性肺炎暘性率低(8.2％),病理確診需外科肺活檢.結論 過敏性肺炎診斷睏難,部分病例可通過暴露病史、影像、BALF做齣臨床診斷,但是噹上述錶現不典型時,需藉助病理進行臨床-影像-病理綜閤診斷.
목적 제고대과민성폐염적인식급진단수평.방법 회고성분석2001년1월지2011년6월북경협화의원96례과민성폐염환자적림상자료,분위림상진단조(49례)급병리진단조(47례),종림상표현、실험실검사、치민원、폐공능、흉부CT표현、BALF세포학등방면진행종합분석.결과 96례환자중녀58례(60.4％),중위년령53세；치민원이소분자화학물질(42.7％)이급동물단백(37.5％)다견；상견림상표현위기단(90.6％)、해수(76.0％)；폐공능이미산공능장애(73.5％)이급한제성통기공능장애(59.7％)위주；영상학제표현위마파리영(64.6％)、소협중심성결절영(21.9％)、기체함폐정(15.6％)외,환가견망격영(45.8％)、견장성지기관확장(21.9％)이급봉와폐(9.4％)표현；BALF세포학림파세포계수＞0.2이급CD4/CD8 ＜0.9적비례재병정＜1년적환자중경고；병리진단조여림상진단조비교,재년령、성별분포이급림상표현、폐공능손해、영상학개변등방면구유교위일치적특점,단시병리진단조병정경장(분별위24화6개월,Z=-2.492,P=0.013),저상지지(분별위23.4％화8.2％,x2=4.227,P=0.040)、미산공능장애(분별위90.7％화44.0％,x2=35.219,P＜0.01)이급망격、견장성지기관확장、봉와폐(분별위57.5％화26.5％,x2=9.434,P＜0.01)표현경가돌출；경지기관경폐활검진단과민성폐염양성솔저(8.2％),병리학진수외과폐활검.결론 과민성폐염진단곤난,부분병례가통과폭로병사、영상、BALF주출림상진단,단시당상술표현불전형시,수차조병리진행림상-영상-병리종합진단.
Objective To improve understanding of the clinical characteristics and diagnosis of hypersensitivity pneumonitis (HP).Methods We retrospectively analyzed the clinical data,including clinical symptoms,laboratory tests,exposure,pulmonary function tests,chest CT imaging and cytological classification of bronchoalveolar lavage(BAL) of 96 patients with HP from Jan 2001 to Jun 2011 in Peking Union Medical College Hospital.We divided the patients into 2 groups:a pathologically-confirmed group and a clinically-suspected group.Results There were 58 females and 41 males.The median age at the diagnosis was 53 years.The most common exposures were low-molecular-weight chemicals (42.7％) and animal proteins (37.5％).Common clinical symptoms included dyspnea on exertion (90.6％) and cough (76.0％).Pulmonary function test showed diffusion abnormality (73.5％) and restrictive ventilatory impairment(59.7％).Chest CT scan revealed patchy or diffuse bilateral ground-glass opacities (64.6％),centrilobular nodules (21.9％),and air trapping (15.6％).Reticulation (45.8％),traction bronchiectasis (21.9％) and honeycombing (9.4％) were present in chronic HP.BAL lymphocyte counts ＞ 0.2 and CD4/CDs ＜ 0.9 were more commonly seen in patients with a disease course of less than 1 year.The pathologically-confirmed group and the clinically-suspected group shared many similar characteristics including age at diagnosis,gender,clinical manifestation,pulmonary function impairments and imaging findings,but significant differences existed in certain parameters.In the pathologicallyconfirmed group,the duration of disease was longer (24 months vs 6 months,Z =-2.492,P =0.013) and clubbed fingers were more common (23.4％ vs 8.2％,x2 =4.227,P =0.040).Diffusion abnormality was present in more patients of this group (90.7％ vs 44.0％,x2 =35.219,P ＜ 0.01).By CT scan,reticulation,traction bronchiectasis and honeycombing (57.5％ vs 26.5％,x2 =9.434,P ＜ 0.01) were more evident as compared to the clinically-suspected group.The value of transbronchial lung biopsy for diagnosing HP was limited,with a positive result of only 8.2％.Surgical lung biopsy was needed in uncertain cases.Conclusion The diagnosis of HP was difficult.In some cases a clinical diagnosis can be made by combination of history of exposure,CT manifestations and cell classification of BAL.For atypical cases a multi-disciplinary approach including pathologists,radiologists and pulmonologists is needed.
