慢性嗜酸性粒细胞性肺炎五例临床分析  

Chronic eosinophilic pneumonia: five cases report

作　　者：杨天芸[1] 韩锋锋[1] 宋琳[1] 孙晋渊[1] 彭娟[1] 管雯斌[2] 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

出　　处：《中国呼吸与危重监护杂志》2017年第3期265-270,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的总结慢性嗜酸性粒细胞性肺炎的临床特点、诊断及治疗方法,提高诊治水平。方法回顾性分析2011年1月至2015年1月5例慢性嗜酸性粒细胞性肺炎患者的临床资料。结果患者中男2例,女3例。合并过敏性鼻炎1例,合并支气管哮喘2例,具有过敏史者2例,合并变应性皮疹1例。主要临床表现为发热、咳嗽、咯痰、呼吸困难和胸痛,常伴乏力、纳差和体重下降。主要体征为两肺湿啰音、散在哮鸣音,亦可闻及爆裂音。5例均有外周血嗜酸性粒细胞计数升高,嗜酸性粒细胞百分比升高,支气管肺泡灌洗液中嗜酸性粒细胞百分比明显升高。主要影像表现为两肺浸润影,斑片实变影和磨玻璃影。5例均接受糖皮质激素治疗。随访中病情复发1例。结论慢性嗜酸性粒细胞性肺炎起病隐匿,临床表现缺乏特异性,常合并哮喘及变应性皮炎,多数患者外周血和肺泡灌洗液嗜酸性粒细胞数明显升高,典型影像表现为周边和胸膜下分布为主的肺浸润影。ObjectiveTo summarize the clinical manifestations, diagnosis and treatments of chronic eosinophilic pneumonia （CEP）.MethodsThe clinical and pathological data of five patients with CEP diagnosed in this hospital between January 2011 and January 2015 were retrospectively analyzed.ResultsThere were five CEP cases including two males and three females, and one case with allergic rhinitis, two cases with bronchial asthma, two cases with allergic history, and one case with allergic skin rash. The main clinical manifestations were fever, cough, expectoration, shortness of breath and chest pain, and often accompanied by fatigue, anorexia and weight loss. The main signs included moist rales, scattered wheeze and crackles. There were significantly increased peripheral blood eosinophils count, the proportion of eosinophils, and the proportion of eosinophils in bronchoalveolar lavage fluid in all five cases. The main imaging features were airway infiltration, real change shadow and ground glass shadow. All of five cases were treated with glucocorticoid, and one of them relapsed during follow-up.ConclusionsThe onset of CEP is insidious. The clinical manifestations of CEP are lack of specificity, and often associate with asthma and allergic dermatitis. Eosinophils significantly increase in peripheral blood and bronchoalveolar lavage fluid in most of CEP patients. The typical image is peripheral and subpleural distribution of lung infiltrates.

关 键 词：慢性嗜酸性粒细胞性肺炎 诊断 治疗 病理 

分 类 号：R563.1[医药卫生—呼吸系统]