中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2015年
5期
426-430
,共5页
梁琼%陈一强%孔晋亮%潘熠平
樑瓊%陳一彊%孔晉亮%潘熠平
량경%진일강%공진량%반습평
嗜酸性肺部疾病%肺嗜酸性粒细胞增多%支气管肺泡灌洗液%活组织检查%糖皮质激素类
嗜痠性肺部疾病%肺嗜痠性粒細胞增多%支氣管肺泡灌洗液%活組織檢查%糖皮質激素類
기산성폐부질병%폐기산성립세포증다%지기관폐포관세액%활조직검사%당피질격소류
Eosinophilic lung disease%Pulmonary eosinophilia%Bronchoalveolar lavage fluid%Biopsy%Glucocorticoids
目的 通过分析嗜酸性肺部疾病的临床资料,总结诊断和治疗经验,以提高对该类疾病的认识.方法 回顾性分析2004年1月-2012年8月广西医科大学第一附属医院临床诊断为嗜酸性肺部疾病的25例临床资料,包括病因、临床表现、影像、病理特点和诊治等资料.结果 25例嗜酸性肺部疾病者中,慢性嗜酸性粒细胞肺炎(CEP)9例;变应性肉芽肿性血管炎(CSS)6例;10例寄生虫感染所致嗜酸性肺部疾病,其中2例为单纯性肺嗜酸性粒细胞增多症(L(o)ffler综合征).25例患者外周血、支气管肺泡灌洗液(BALF)中嗜酸性粒细胞增多;有不同程度的低氧血症,肺功能呈限制性、阻塞性、混合性通气功能障碍;胸部CT:两肺片状、条索状或弥漫分布片状磨玻璃浸润影和网状影改变浸润影;肺组织病理学检查或皮肤活检见大量嗜酸性粒细胞浸润.糖皮质激素单独或联用免疫抑制剂治疗有效.结论 嗜酸性肺部疾病的主要病因以寄生虫感染最为常见,其次为不明原因的慢性嗜酸性粒细胞性肺炎.除CSS诊断需组织病理学证据外,嗜酸性肺部疾病大部分病例依据临床表现、实验室检查、BALF和胸部影像学资料可做出临床诊断.
目的 通過分析嗜痠性肺部疾病的臨床資料,總結診斷和治療經驗,以提高對該類疾病的認識.方法 迴顧性分析2004年1月-2012年8月廣西醫科大學第一附屬醫院臨床診斷為嗜痠性肺部疾病的25例臨床資料,包括病因、臨床錶現、影像、病理特點和診治等資料.結果 25例嗜痠性肺部疾病者中,慢性嗜痠性粒細胞肺炎(CEP)9例;變應性肉芽腫性血管炎(CSS)6例;10例寄生蟲感染所緻嗜痠性肺部疾病,其中2例為單純性肺嗜痠性粒細胞增多癥(L(o)ffler綜閤徵).25例患者外週血、支氣管肺泡灌洗液(BALF)中嗜痠性粒細胞增多;有不同程度的低氧血癥,肺功能呈限製性、阻塞性、混閤性通氣功能障礙;胸部CT:兩肺片狀、條索狀或瀰漫分佈片狀磨玻璃浸潤影和網狀影改變浸潤影;肺組織病理學檢查或皮膚活檢見大量嗜痠性粒細胞浸潤.糖皮質激素單獨或聯用免疫抑製劑治療有效.結論 嗜痠性肺部疾病的主要病因以寄生蟲感染最為常見,其次為不明原因的慢性嗜痠性粒細胞性肺炎.除CSS診斷需組織病理學證據外,嗜痠性肺部疾病大部分病例依據臨床錶現、實驗室檢查、BALF和胸部影像學資料可做齣臨床診斷.
목적 통과분석기산성폐부질병적림상자료,총결진단화치료경험,이제고대해류질병적인식.방법 회고성분석2004년1월-2012년8월엄서의과대학제일부속의원림상진단위기산성폐부질병적25례림상자료,포괄병인、림상표현、영상、병리특점화진치등자료.결과 25례기산성폐부질병자중,만성기산성립세포폐염(CEP)9례;변응성육아종성혈관염(CSS)6례;10례기생충감염소치기산성폐부질병,기중2례위단순성폐기산성립세포증다증(L(o)ffler종합정).25례환자외주혈、지기관폐포관세액(BALF)중기산성립세포증다;유불동정도적저양혈증,폐공능정한제성、조새성、혼합성통기공능장애;흉부CT:량폐편상、조색상혹미만분포편상마파리침윤영화망상영개변침윤영;폐조직병이학검사혹피부활검견대량기산성립세포침윤.당피질격소단독혹련용면역억제제치료유효.결론 기산성폐부질병적주요병인이기생충감염최위상견,기차위불명원인적만성기산성립세포성폐염.제CSS진단수조직병이학증거외,기산성폐부질병대부분병례의거림상표현、실험실검사、BALF화흉부영상학자료가주출림상진단.
Objective To improve the diagnosis and treatment of eosinophilic lung disease.Methods Patients who were diagnosed with eosinophilic lung disease and hospitalized in the First Affiliated Hospital of Guangxi Medical University Hospital were retrospectively analyzed from January 2004 to August 2012.Data of etiology,clinical manifestation,imaging and pathological features,diagnosis and treatment were recorded.Results A total of 25 patients were diagnosed with eosinophilic lung disease including 9 chronic eosinophilic pneumonia,6 churg-strauss syndrome,and 10 cases of parasitic infection of which two patients were the simple pulmonary eosinophilia (L(o)ffler syndrome).Eosinophil counts in peripheral blood and bronchoalveolar lavage fluid (BALF) were increased.Arterial gas analysis showed varying degree of hypoxemia,which pulmonary function tests showed restrictive,obstructive,mixed ventilatory dysfunction.Chest CT showed bilateral flaky,streak or flake diffuse ground-glass infiltrates and reticular opacities.Results of pulmonary biopsy or skin biopsy identified diffuse eosinophil infiltration.Corticoidsteroid therapy alone or combined with immunosuppressive agents were both effective.Conclusion (1) Liver fluke and other food-borne parasites are the most common causes in eosinophilic lung disease; followed by unexplained chronic acidophilic granulocyte pneumonia; (2) In addition to histopathological evidence,the diagnosis of eosinophilic lung disease was made comprehensively based on clinical features,laboratory test,the BALF analysis,and imaging data.
