经病理确诊的外源性脂质性肺炎12例分析  

Analysis of 12 cases of exogenous lipoid pneumonia confirmed by pathology

作　　者：王玉霞[1] 方芳[2] 郭岩斐[1] 李燕明[1] 孙铁英[1] 张旻[3] 陈涓[3] 方保民[1] Wang Yuxia Fang Fang Guo Yanfei Li Yanming Sun Tieying Zhang Min Chen Juan Fang Baomin(Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Beijing 100730, China)

机构地区：[1]北京医院呼吸与危重症医学科国家老年医学中心,100730 [2]北京医院病理科,100730 [3]北京医院放射科,100730

出　　处：《中华结核和呼吸杂志》2017年第6期445-449,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨外源性脂质性肺炎（ELP）的病因、临床表现、影像学特点、诊断方法、治疗方法及预后，提高临床诊治水平。 方法回顾分析北京医院1953年1月至2016年经病理确诊且临床资料完整的12例ELP病例并进行随访。本研究为回顾性病例研究。结果12例ELP患者中，男9例，女3例，年龄44～100岁，平均73.8岁。基础疾病多种，包括多脏器功能衰竭、慢性心肾功能不全、类天疱疮等影响全身状况的重症疾病，亦包括脑血管后遗症、老年痴呆、鼻咽癌晚期、麻痹性肠梗阻等增加误吸风险的疾病。12例ELP均由误吸矿物油导致。常见症状为咳嗽、咳痰和呼吸困难。肺部体征无特异性。血白细胞、中性粒细胞、ESR、C反应蛋白、降钙素原及D-二聚体等炎症指标和血脂指标未见异常。影像学以实变和结节肿块影为主表现，少数为磨玻璃影。部分患者出现通气和弥散功能障碍。经CT引导肺穿刺活检术、胸腔镜、开胸手术或尸检确诊。病理表现为肺泡腔内大量泡沫细胞，少数可见脂质沉积和多核巨细胞。治疗以停止脂质接触为。12例中，1例因ELP死亡，6例因其他合并疾病死亡，5例好转出院。存活患者随访2～4.5年病情稳定。结论ELP少见，临床表现不典型，影像学易与肺炎、肺癌、肺间质病等疾病混淆。病理检查是确诊的金标准。通常首选支气管镜检查，无法明确诊断者再行CT引导肺穿刺活检术。除停止脂质接触外，无特殊治疗方法。ELP患者预后良好。Objective To study the etiological, clinical, radiological, diagnostic, therapeutic, and prognostic manifestations of exogenous lipoid pneumonia （ELP）, and therefore to improve the diagnosis and treatment of this disease.Methods The clinical data of 12 cases of ELP confirmed by pathology were retrospectively analyzed.Results The patients consisted of 9 males and 3 females, with an average age of 73.8 years （range, 44 to 100 years）. The underlying diseases were variable, including diseases affecting the general condition （multiple organ failure, chronic heart and renal insufficiency, pemphigoid, etc） and conditions with increased risk of aspiration （sequelae of cerebrovascular disease, Alzheimer′s disease, advanced stage of nasopharyngeal carcinoma, paralytic ileus, etc）. The 12 cases were all caused by Inhalation of mineral oil. Common symptoms included cough, sputum production and dyspnea. ELP had no special physical signs. Inflammation indexes, such as white blood cell, neutrophil percentage, ESR, C reactive protein, procalcitonin, D-Dimer, and blood lipid levels were usually normal. Radiological features of ELP mainly included consolidation, mass or nodules, with a little ground-glass opacity. Some patients had ventilation and/or diffusion dysfunction. The diagnostic methods included CT-guided percutaneous lung biopsy, thoracoscopy, thoracotomy or autopsy. Histopathological findings showed accumulation of large foamy macrophages in the alveolar spaces, with a few lipid deposition and polykaryocytes. The main treatment of ELP was cessation of lipid material contact. One case died of ELP, 6 died of other coexisting diseases, and the rest 6 improved with treatment and were discharged. The survival patients were all stable during a follow-up of 2-4.5 years.Conclusions ELP was rare and its clinical manifestation was atypical. Its radiological manifestations were indistinguishable from pneumonia, lung cancer, interstitial lung diseases, etc. Pathological examination was the gold standard for diagno

关 键 词：外源性脂质性肺炎 诊断 病理 泡沫细胞 

分 类 号：R563.1[医药卫生—呼吸系统]