肺嗜酸性粒细胞浸润症临床特点的回顾性分析  

Pulmonary infiltration with eosinophilia: a clinical analysis of forty-eight cases

作　　者：时旭[1] 黄夏飞[1] 谢佳星[1] 张清玲[1] 鲜墨[1] 杨朝崴[1] 顾莹莹[1] 关玉宝[1] 李靖[1] SHI Xu HUANG Xiafei XIE Jiaxing ZHANG Qingling XIAN Mo YANG Zhaowei GU Yingying GUAN Yubao LI Jing(Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China)

机构地区：[1]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,广东广州510120

出　　处：《中国呼吸与危重监护杂志》2017年第2期147-154,共8页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家自然科学基金面上项目(81371633)

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�Objective To improve the diagnosis and treatment of pulmonary infiltration with eosinophilia （PIE）. Methods Patients who were diagnosed with PIE in the First Affiliated Hospital of Guangzhou Medical University from January 2004 to December 2013 were recruited and retrospectively analyzed. Data of etiology, clinical manifestation, imaging and pathological features were recorded. Results pulmonary eosinophilic granuloma （PEG） （n=2）, eosinophilic granulomatosis with polyangiitis （EGPA） （n=7）, L6ffler syndrome （n=4）, allergic bronchopulmonary aspergillosis （ABPA） （n=16）, and chronic eosinophilic pneumonia （CEP） （n=19）. There were 27 males and 21 females. 47.9% of the PIE patients were diagnosed as asthma and treated with regular treatment but had not been controlled well. PEG was characterized with wheeze and anhelation in clinical manifestations, unelevated blood eosinophil counts and percentage, significant small airway abnormalities in lung function, diffuse pneumonectasis in Chest CT, and appearance of eosinophil cells in alveole. EGPA shows dyspnea and cough in clinical manifestations, as well as other organs function damaged, unelevated blood eosinophil counts and percentage, significant FEVJF^C and small airway abnormalities in lung function, tree-in-bud in Chest CT, appearance of eosinophilic granuloma outside blood vessels. L6ffler syndrome also showed cough, shorter course of disease, normal lung function and diffusion. ABPA showed wheeze and cough, 31.3% of them with hemoptysis, normal blood eosinophil count, central bronchiectasis in Chest CT. CEP also showed dyspnea and cough. 21.1% of CEP patientshad chest pain, increasing sputum eosinophil percentage compare with blood eosinophil percentage, and small airway abnormalities in lung function. Conclusions Most of PIE patients are diagnosed as asthma but haven＇t gotten well controlled under the regular anti-asthmatic treatment. Patients with PIE have increasing eosinophil counts and decreasing lung function. The dia

关 键 词：肺嗜酸性粒细胞浸润症 变应性支气管肺曲霉病 嗜酸粒细胞性肉芽肿性血管炎 

分 类 号：R563[医药卫生—呼吸系统]