肉芽肿性肺疾病的临床诊治现状

发布时间：2018-01-06 20:04

本文关键词：肉芽肿性肺疾病的临床诊治现状　出处：《吉林大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景:肉芽肿性肺疾病(Granulomatous Lung Disease,GLD)或称肺肉芽肿病(1ung granulomatosis),是一组病因不同但均以肉芽肿形成为共同病理特征的肺部疾病的总称。肉芽肿性肺疾病在临床上较常见,包括临床上发病率较高的肺结核(pulmonary tuberculosis,TB)和结节病等,也包括临床少见的韦格纳肉芽肿(Wegener’s granulomatosis,WG,也称肉芽肿性多血管炎,granulomatosis with polyangiitis,GPA)、Churg-Strauss综合征(Churg-Stauss Syndrome,CSS,也称变应性肉芽肿性血管炎,allergic granulomatous angiitis,AGA,也称嗜酸性肉芽肿性多血管炎,eosinophilic granulomatosis with polyangiitis,EGPA)以及多种罕见疾病。各种疾病的病因不同,在流行病学、临床表现、影像学表现、实验室检查等方面具有不同的特点,在治疗方法上也存在很大差别。目的:探讨肉芽肿性肺疾病的临床特点,归纳其现有的诊断和治疗方法,以利于提高对肉芽肿性肺疾病的认识及诊疗水平。方法:通过检索Pub Med、CNKI、万方数据库等,搜集筛选相关中英文文献,总结肉芽肿性肺疾病的病因和发病机制以及肺结核、结节病、韦格纳肉芽肿、Churg-Strauss综合征等四种疾病的流行病学、临床表现、诊断、治疗等各方面的研究现状,将对临床工作有指导意义的内容予以归纳,并总结肺结核与结节病、韦格纳肉芽肿与Churg-Strauss综合征鉴别诊断的要点。结论:肉芽肿性肺疾病根据肉芽肿形成的病因,可分为感染性和非感染性两类。非感染性肉芽肿性肺疾病包括多种病因尚未明确的疾病,国内外文献认为遗传、环境、免疫、感染等多种因素参与其发病,但尚无统一共识。肉芽肿的形成是各种肉芽肿性肺疾病共同的病理学特征,而各种类型又具有各自的特点,常是诊断和鉴别诊断的关键证据。这些疾病在流行病学、临床表现、影像学表现、实验室检查等方面具有一定的特点,可以为临床诊断提供线索,但尚缺乏特异性和敏感性均较高的诊断手段。感染性肉芽肿性肺疾病的治疗主要是有效的抗感染和对症支持治疗。结节病、韦格纳肉芽肿、Churg-Strauss综合征等非感染性肉芽肿性肺疾病的治疗主要是糖皮质激素和免疫抑制剂,手段单一,疗程长,长期应用不良反应多,而且用量和减量速度不当可能会造成病情反复。肉芽肿性肺疾病的预后与早期有效的治疗密切相关。此外,某些类型与疾病累及脏器、有无并发症等因素有关。
[Abstract]:Background: granulomatous Lung Disease. GLDs, or pulmonary granulomatosis). Granulomatous lung disease is a group of pulmonary diseases with different etiology but common pathological features of granuloma. Granulomatous lung disease is common in clinical practice. It includes pulmonary tuberculosis tuberculosis (TBB) and sarcoidosis with high incidence in clinic. Also included in the clinical rare Wegener's granulomatosis or WGG, also known as granulomatous polyvasculitis. Granulomatosis with polyangiitis (GPA). Churg-Strauss syndrome Churg-Stauss Syndromesis-CSSs, also known as allergic granulomatous vasculitis. Allergic granulomatous angitisAGA, also known as eosinophilic granulomatous polyvasculitis. Eosinophilic granulomatosis with polyangiitis) and a variety of rare diseases. The etiology of various diseases is different. There are different characteristics in epidemiology, clinical manifestation, imaging manifestation, laboratory examination and so on. Objective: to explore the clinical characteristics of granulomatous lung disease. The existing diagnosis and treatment methods were summarized in order to improve the understanding and diagnosis and treatment of granulomatous lung diseases. Methods: by searching Pub Med#en0#, Wanfang database and so on. To summarize the etiology and pathogenesis of granulomatous lung disease, pulmonary tuberculosis, sarcoidosis and Wegener's granuloma. The research status of epidemiology, clinical manifestation, diagnosis and treatment of Churg-Strauss syndrome and other four diseases will be summarized. The main points of differential diagnosis between pulmonary tuberculosis and sarcoidosis, Wegener's granuloma and Churg-Strauss 's syndrome were summarized. Conclusion: granulomatous pulmonary disease is based on the etiology of granuloma. Noninfectious granulomatous lung disease includes many diseases whose etiology is not clear, and many factors such as heredity, environment, immunity, infection and so on are considered to be involved in the disease. However, there is no unified consensus. Granuloma formation is the common pathological characteristics of various granulomatous lung diseases, and each type has its own characteristics. These diseases have some characteristics in epidemiology, clinical manifestation, imaging manifestation, laboratory examination and so on, which can provide clues for clinical diagnosis. However, there is still a lack of specificity and sensitivity of the diagnostic methods. Infectious granulomatous lung disease treatment is mainly effective anti-infection and symptomatic support treatment. Sarcoidosis, Wegener granuloma. The treatment of non-infectious granulomatous lung diseases such as Churg-Strauss syndrome is mainly glucocorticoid and immunosuppressant. The prognosis of granulomatous lung disease is closely related to the early effective treatment.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.9

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