临床非特异性间质性肺炎3例报告及文献复习  

Clinical Report of 3 Cases of Nonspecific Interstitial Pneumonia and the Review of Relative Research Papers

作　　者：温雪萍[1] 王忠慧[1] 张丽君[1] 颜志军[1] 李艳[1] 

机构地区：[1]上海瑞金医院集团闵行医院呼吸内科

出　　处：《中国临床医学》2007年第3期331-333,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨非特异性间质性肺炎(NSIP)的临床特征。方法:对3例经支气管镜肺活检病理诊断的NSIP患者的发病诱因、临床表现、影像学、肺功能检查、病理资料及预后进行回顾分析。结果:3例中女性2例,男性1例,平均年龄45～47岁;发病至就诊时间15 d～4个月。发病前有吸烟史1例,慢性胃炎1例,3例均有咳嗽、进行性呼吸困难,2例有吸气相爆裂音,有发热和杵状指各1例。胸部高分辨CT(HRCT)均示有弥漫性斑片状磨玻璃样变,以两下肺及胸膜下为甚。肺功能检查示2例为限制性肺通气功能障碍,1例为混合性肺通气功能障碍,低氧血症1例。组织类型:细胞型2例,混合型1例。1例低氧血症给予无创机械通气治疗,3例均给予糖皮质激素治疗后病情明显好转。结论:对中年以上的患者,临床表现、胸部影像学等检查拟诊为间质性肺病变者要及时行支气管镜肺活检,以明确NSIP的病理诊断及组织学类型。确诊NSIP患者,加用糖皮质激素治疗可提高临床治疗效。Objective： To discuss the clinical feature of nonspecific interstitial pneumonia（NSIP）. Methods： The predisposing cause , clinical feature, thoracic imaging, pulmonary function, pathology feature and prognosis of 3 patients with nonspecific interstitial pneumonia by pathology diagnosis through bronchoscopy lung biopsy were revidwed. Results： Among the 3 cases, 2 were femal, lwas male; the average age was 45-47 years old. And the period between pathogeny time and the diagnostic time was from 15 days to 4 months. 1 case had smoking history, lcase had chronic gastritis, 3 cases all had cough and progressive dyspneic respiration, 2cases had inspiratory crackles, 1 case had fever and 1 case had clubbed finger. The chest high-resolution CT scans showed diffuse,macular glass changes, especially in the two lower lungs and under pleura. In the pulmonary function tests, 2 cases were restrictive ventilatory functional disturbance, 1 case was mixed ventilatory dysfunction, 1 case had hypoxemia. In the tissue type, 2 cases were cell type, lcase was mixed. 1 case was given non-invasive and face-masked mechanical ventilation for hypoxemia. The condition of the 3 cases all got amendment after having glucocorticoid. Conclusion：The middle age patients, with nonspecific interstitial pneumonia in clinical feature and thoracic imaging should receive bronchoscopy lung biopsy in time to explicit pathologic diagnosis and tissue type. When we confirmed diagnosed the patient as nonspecific interstitial pneumonia, glucocorticoid should be given to raise the therapeutic effectiveness.

关 键 词：支气管镜检查 肺活检 非特异性间质性肺炎 

分 类 号：R563.13[医药卫生—呼吸系统]