外源性脂质性肺炎九例临床分析  

Exogenous lipid pneumonia: a clinical analysis of 9 cases

作　　者：李钊[1] 曹新娜 胡依粉 宋敏[1] 姜鲁宁[1] Li Zhao;Cao Xinna;Hu Yifen;Song Min;Jiang Luning(Department of Pulmonary and Critical Care Medicine,Affiliated Hospital of Jining Medical University,Jining 272029,China;Bronchoscopy Unit,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院呼吸与危重症医学科,272029 [2]济宁医学院附属医院气管镜室,272029

出　　处：《中华全科医师杂志》2020年第5期441-443,共3页Chinese Journal of General Practitioners

基　　金：济宁市科技发展计划项目(济科字(2016)56-29)。

摘　　要：回顾分析2013年6月至2018年12月在济宁医学院附属医院经支气管镜肺活检病理确诊的9例外源性脂质性肺炎患者的临床资料,包括病史、临床表现、影像学特征、支气管镜表现、组织病理学、治疗及预后等。9例患者中,男性4例,女性5例,年龄57~79岁,均有肠梗阻及口服液体石蜡史。8例患者临床表现为咳嗽、咳痰及发热,5例患者合并憋喘,所有患者均可闻及干、湿啰音。受累肺叶以右肺下叶最常见,9例患者均累及右肺下叶,其次受累肺叶为左肺下叶、右肺上叶及中叶(分别6例)。胸部CT表现以渗出(7例)和实变(6例)最多见,其次为小叶间隔增厚(5例)及胸腔积液(4例);病灶呈近似脂肪低密度改变(3例)为其相对特异性影像学表现。经支气管镜肺活检病理结果示间质纤维组织增生伴慢性炎细胞浸润及脂肪细胞样细胞。经糖皮质激素及反复肺泡灌洗治疗后好转6例,死亡1例,自动出院2例。提示外源性脂质性肺炎的临床表现和影像学表现缺乏特异性,经支气管镜肺活检技术是有效的确诊手段,反复肺泡灌洗联合糖皮质激素等治疗有效。The clinical data of 9 patients with exogenous lipid pneumonia confirmed by pathology were retrospectively analyzed.There were 4 males and 5 females,aged 57-79 years,with a history of intestinal obstruction and oral administration of liquid paraffin.The main clinical symptoms were cough,expectoration and fever(8 cases),and combined with wheezing(5 case);and crackles and rhonchi were revealed on chest auscultation in all patients.The right lung lower lobe was involved in all 9 cases,the left lower lobe,right middle and lower lobe were also involved in 6 case.The CT scan showed that infiltration(7 case)and consolidation(6 case)were the most common imaging features,followed by the septal thickening(5 case)and pleural effusion(4 case);the low density fat-like changes within the consolidative opacities was a specific feature of lipid pneumonia(3 case).The lung biopsy was performed in the target site through bronchoscope,and pathology showed the interstitial fibrous tissue hyperplasia with chronic inflammatory cell infiltration and adipocyte-like cells.Six patients were treated with glucocorticoid and repeated bronchoalveolar lavage with good response,one cases died and two cases discharged automatically.The clinical manifestation and imaging features of exogenous lipid pneumonia are lack of specificity;transbronchial lung biopsy is an effective method for the diagnosis.The repeated bronchoalveolar lavage with saline combined with medication of glucocorticoids are effective for the treatment of exogenous lipid pneumonia.

关 键 词：肺炎 脂质性 支气管镜 诊断 

分 类 号：R563[医药卫生—呼吸系统]