肺嗜酸性粒细胞浸润症临床特点的回顾性分析

发布时间：2018-03-15 05:22

本文选题：肺嗜酸性粒细胞浸润症　切入点：变应性支气管肺曲霉病　出处：《中国呼吸与危重监护杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的观察肺嗜酸性粒细胞浸润症(PIE)的临床资料,探讨PIE的临床特点和诊断经验,提高对该类疾病的认识。方法回顾分析2004年1月至2013年12月广州医科大学附属第一医院临床诊断的48例PIE患者的一般资料、临床表现、实验室检查、影像和病理学检查等。结果 48例PIE患者中男27例,女21例,肺嗜酸粒细胞性肉芽肿(肺组织细胞增生症X,PEG)2例,嗜酸粒细胞性肉芽肿性血管炎(EGPA)7例,单纯性肺嗜酸性粒细胞增多症(L?ffler综合征)4例,变应性支气管肺曲菌病(ABPA)16例和慢性嗜酸性粒细胞肺炎(CEP)19例。47.9%的PIE患者曾被诊断哮喘,接受哮喘的规范性治疗但症状仍控制不佳。PEG以喘息、气促为主要表现;外周血嗜酸性粒细胞计数和百分比无明显增高;肺功能以小气道受损明显;影像学见双肺弥漫性小囊状透亮区;病理见肺泡腔嗜酸性粒细胞浸润。EGPA以喘息、咳嗽为主要特征,PIE患者中仅其存在其他器官受累,如四肢麻木;外周血中嗜酸性粒细胞计数、百分比及诱导痰嗜酸性粒细胞百分比增高;肺功能FEV1/FVC和小气道均受损;影像学以树芽征改变为主,且有游走性;病理示PIE中有且仅有本病可见血管外嗜酸性肉芽肿。L?ffler综合征以咳嗽为主,病程短、喘息少见;外周血中嗜酸性粒细胞计数、百分比和诱导痰嗜酸性粒细胞百分比增高常见;肺基础通气和弥散功能无明显下降;影像学示双肺散在密度较淡、边缘欠清的云絮状阴影;病理见肺泡腔、肺间质或血管腔内嗜酸性粒细胞浸润。ABPA临床症状以喘息、咳嗽为最常见,31.3%的ABPA可出现咯血;血嗜酸粒性细胞百分比无显著增高,FEV_1/FVC和小气道均存在明显受损;PIE的影像学仅有ABPA存在中心性支气管扩张;病理示支气管管壁或肺间质嗜酸性粒细胞浸润。CEP以喘息、咳嗽为主,21.1%的CEP表现胸痛;诱导痰嗜酸性粒细胞百分比增高较外周血嗜酸性粒细胞增高更显著;肺功能示其仅存在小气道受损;影像学示84.2%的CEP病灶呈肺周围型胸膜下分布;病理示肺泡腔、肺间质或血管腔内嗜酸性粒细胞浸润。结论 PIE患者大部分以哮喘为初步诊断,即使规范治疗,症状仍控制不佳,应完善相关检查以明确PIE诊断;PIE患者外周血嗜酸性粒细胞增多,多存在肺功能受损,此类疾病的诊断仍主要依据临床表现、实验室检查和影像学、病理学资料做出诊断。
[Abstract]:Objective to observe the clinical data of pulmonary eosinophilic granulocytic infiltration (pie) and to explore the clinical features and diagnostic experience of PIE. Methods from January 2004 to December 2013, 48 patients with PIE diagnosed in the first affiliated Hospital of Guangzhou Medical University were analyzed retrospectively. Results among 48 PIE patients, 27 were male, 21 were female, 2 were pulmonary histiocytosis, 7 were ePAA, 2 were pulmonary histiocytosis, 7 were eosinophilic granulomatous vasculitis. Simple pulmonary eosinophilia? 4 cases of ffler syndrome, 16 cases of allergic bronchopulmonary aspergillosis and 19 cases of chronic eosinophil pneumonia were diagnosed with asthma. The number and percentage of eosinophils in peripheral blood were not significantly increased, the lung function was obviously damaged in small airway, the diffuse small cystic bright area was seen on imaging, and the eosinophil infiltration in alveolar cavity was observed by pathology. In patients with cough, only other organs were involved, such as limb numbness, eosinophil count in peripheral blood, percentage of eosinophil in induced sputum, FEV1/FVC of lung function and small airway damage. The main imaging changes were tree-bud sign and migration, and the pathology showed that there was extravascular eosinophilic granulomatosis in PIE and only the disease could be seen in the pathophysiology of Eosinophilic granulomatosis. Ffler syndrome was characterized by cough, short course of disease and rare wheezing; eosinophil count, percentage and percentage of induced sputum eosinophil were increased in peripheral blood; The imaging findings showed that the density of double lungs was light and the margin was not clear, the pulmonary alveolar cavity, pulmonary interstitial or vascular eosinophils infiltrated with eosinophils infiltration. The clinical symptoms of ABPA were wheezing, and the most common ABPA with cough was 31. 3% hemoptysis. There was no significant increase in the percentage of eosinophil cells in the blood. The imaging images of significant damage to both FEV1 / FVC and small airway showed that only ABPA had central bronchiectasis, pathologically, eosinophil infiltration in the bronchial wall or pulmonary interstitial. The percentage of eosinophil in induced sputum was significantly higher than that in peripheral blood eosinophil was higher than that in peripheral blood. Pulmonary function showed that there was only small airway damage in 84.2% of CEP lesions. The pathology showed eosinophil infiltration in alveolar cavity, pulmonary interstitial or vascular lumen. Conclusion most of PIE patients are diagnosed with asthma, and the symptoms are still not well controlled even after standardized treatment. The relevant examination should be improved to make sure that the peripheral blood eosinophils increase and lung function is damaged in patients with PIE. The diagnosis of these diseases is still mainly based on the clinical manifestation, laboratory examination, imaging and pathological data.
【作者单位】：广州医科大学附属第一医院呼吸疾病国家重点实验室广州呼吸疾病研究所变态反应科;
【基金】：国家自然科学基金面上项目(81371633)
【分类号】：R563

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