过敏性肺炎96例临床特征分析  

Clinical characteristic analysis of 96 cases of hypersensitivity pneumonitis

作　　者：金贝贝[1] 许文兵[1] 彭敏[1] 施举红[1] 田欣伦[1] 留永健[1] 冯瑞娥[2] 刘鸿瑞[2] 蔡柏蔷[1] 邵池[1] 黄慧[1] 柳涛[1] 张弘[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《中华结核和呼吸杂志》2013年第2期83-87,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：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％，X^2=4．227，P=0．040）、弥散功能障碍（分别为90．7％和44．0％，X^2=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％，X^2=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。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 bronehiectasis （ 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% , X^2 =4. 227, P =0. 040）. Diffusion abnormality was present in more patients of this group （90. 7% vs 44. 0%, X^2 = 35. 219, P 〈 0. 01 ）. By CT scan, reticulation, traction bronchiectasis and honeycombing （57. 5%

关 键 词：肺泡炎 外源变应性 回顾性研究 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]