吸入异氰酸酯致外源性变应性肺泡炎报告并文献复习  

Extrinsic Allergic Alveolitis Induced by Suction Isocyanate: A Case Report and Literature Review

作　　者：孙晋渊[1] 韩锋锋[1] 黄雁西[1] 管雯斌[2] 李惠民[3] 郭雪君[1] 

机构地区：[1]上海交通大学医学院附属新华医院呼吸科,上海200092 [2]上海交通大学医学院附属新华医院病理科,上海200092 [3]上海交通大学医学院附属新华医院放射科,上海200092

出　　处：《临床误诊误治》2014年第5期18-21,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨外源性变应性肺泡炎(extrinsic allergic alveolitis,EAA)的临床特点及诊疗思路。方法回顾分析1例吸入异氰酸酯所致EAA的诊治经过,并复习相关文献。结果患者表现为反复咳嗽、发热及活动后气促。外院胸部高分辨率CT(HRCT)检查示双肺弥漫性间质病变,诊断为间质性肺炎,予相应治疗病情无好转。入我科后追问病史,发现有异氰酸酯吸入史。支气管肺泡灌洗液(BALF)细胞分类淋巴细胞增多。转胸外科行右下肺楔形切除术,术后病理检查确诊EAA。予甲泼尼龙治疗14个月,临床症状及胸部HRCT表现均得到明显改善。结论胸部HRCT检查对EAA的诊断和鉴别诊断有较大价值,肺活组织病理检查是其确诊手段。随着工业发展,临床医师应警惕吸入异氰酸酯等小分子化合物所致EAA。Objective To explore the clinical features and treatment of extrinsic allergic alveolitis（ EAA）. Methods The diagnosis and treatment of one patient with EAA induced by isocyanate suction was reviewed,and the relevant literature was also reviewed. Results The patient suffered chronic cough,fever and accelerated breathing after activities. In other hos-pitals,the chest high-resolution computed tomography（ HRCT）showed diffuse interstitial substance pathological changes in hibateral pulmones,and the patient was diagnosed as having interstitial pneumonia,but the patient′s condition did not improve after corresponding treatment. In our department,the patient was found to have a history of isocyanate suction after history en-quiry. Lymphocytosis was found after bronchoalveolar lavage fluid（BALF）cell classification. After the thoracic surgery,right＆amp;nbsp;pulmonary wedge resection was performed,and then the diagnosis of EAA was confirmed by postoperative pathological exami-nation. The patient′s manifestations and chest HRCT symptoms significantly improved after methylprednisolone therapy for four-teen months. Conclusion Chest high resolution computed tomography（ HRCT）has great value in diagnosis and differential diagnosis of EAA. Pathologic examination of pulmonary living tissue can be used to confirm the diagnosis. With developing in-dustry,clinicians should be alert to EAA induced by suction of small molecular compounds such as isocyanate.

关 键 词：肺泡炎 外源性变应性 肺疾病 间质性 误诊 

分 类 号：R563.19[医药卫生—呼吸系统]