嗜酸性粒细胞性肺疾病33例临床分析  

Clinical analysis on 33 cases of eosinophilic pulmonary disease

作　　者：涂彬彬 许爱国[1] Tu Binbin;Xu Aiguo(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院呼吸与危重症医学科,450052

出　　处：《中国实用医刊》2020年第3期14-18,共5页Chinese Journal of Practical Medicine

基　　金：河南省高等学校重点科研项目(16B310008)。

摘　　要：目的总结嗜酸性粒细胞性肺疾病(ELD)的诊断与治疗经验,提高对该类疾病的诊治水平。方法回顾性分析2016年1月至2019年1月于郑州大学第一附属医院呼吸科确诊并住院治疗的33例ELD患者的临床资料,包括病史、病程、临床表现、实验室检查、影像学检查、病理结果、诊疗及预后等资料。结果33例ELD患者中,男19例,女14例,年龄(41.30±14.26)岁。其中变应性肺曲霉病20例,慢性嗜酸性粒细胞肺炎8例,嗜酸性肉芽肿性多血管炎5例。33例患者均行外周血检测,其中27例患者外周血嗜酸性粒细胞增多。28例行血清总IgE检测,25例血清总IgE增高。26例行肺功能检查,18例有肺通气功能障碍,8例伴有弥散功能障碍。胸部CT显示以肺部浸润为主,肺部可见斑片状、条索状、团块状、磨玻璃样高密度影。肺组织病理检查可见嗜酸性粒细胞浸润。单独应用糖皮质激素或联合其他药物对ELD治疗有效。结论ELD临床表现多样,极易误诊,其诊断主要结合临床表现、实验室检查、影像学检查,必要时可行肺组织活检病理学检查。糖皮质激素是治疗ELD的基础药物。Objective To summarize the experience of diagnosis and treatment of eosinophilic lung disease (ELD), and to improve the diagnosis and treatment of such diseases.Methods Retrospective analysis was performed on clinical data from 33 patients with ELD diagnosed and hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2016 to January 2019, including medical history, course of disease, clinical manifestations, laboratory examination, imaging examination, and pathological results, diagnosis and treatment and prognosis.Results Among the 33 patients with ELD, 19 patients were males and 14 patients were females, with an average age of (41.30±14.26)years. There were 20 cases of allergic bronchopulmonary aspergillosis (ABPA), 8 cases of chronic eosinophilic pneumonia (CEP), and 5 cases of eosinophilic granulomatous polyangiitis (EGPA) among the 33 ELD patients. Thirty-three patients all underwent peripheral blood determination, and peripheral blood eosinophils (EOS) increased in 27 patients. Twenty-eight patients underwent serum total immunoglobulin E(IgE) determination, and 25 patients of them had elevated serum total IgE. Twenty-six patients underwent pulmonary function tests, and 18 of them had pulmonary dysfunction, and 8 patients had diffuse dysfunction. Thoracic computed tomography showed mainly infiltration in the lungs, with patchy, strip-like, clump-like, and ground-glass-like high-density shadows in the lungs. Pathological examination of lung tissue showed eosinophil infiltration. Glucocorticoid alone or in combination with other drugs is effective in the treatment of ELD.Conclusions ELD has a variety of clinical manifestations, for which resaon the disease could be misdiagnosed easily. Its diagnosis mainly depends on clinical manifestations, laboratory tests, imaging examinations. And lung histopathology should be performed for diagnosis if necessary. Glucocorticoid is the basic drug for ELD treatment.

关 键 词：嗜酸性粒细胞性肺疾病 嗜酸性粒细胞 肺组织活检 糖皮质激素 

分 类 号：R563[医药卫生—呼吸系统]