急性间质性肺炎2例  

Two case reports of acute interstitial pneumonia in children

作　　者：姚瑶[1] 熊焰[2] 段晓岷[3] 冯雪莉[1] 邓志娟[4] 刘秀云[1] 徐保平[1] Yao Yao;Xiong Yan;Duan Xiaomin;Feng Xueli;Deng Zhijuan;Liu Xiuyun;Xu Baoping(China National Clinical Research Center for Respiratory Diseases,Department of Respiratory,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pathology,Peking University First Hospital,Beijing 100034,China;Department of Radiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pathology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院呼吸科,国家呼吸系统疾病临床医学研究中心,北京100045 [2]北京大学第一医院病理科,100034 [3]国家儿童医学中心,首都医科大学附属北京儿童医院放射科,北京100045 [4]国家儿童医学中心,首都医科大学附属北京儿童医院病理科,北京100045

出　　处：《中华实用儿科临床杂志》2020年第18期1428-1430,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：对2016年1月至2017年12月首都医科大学附属北京儿童医院呼吸科诊断的2例急性间质性肺炎(AIP)患儿的临床表现、影像学变化及病理表现进行回顾性分析。例1,女,8岁4个月;例2,男,1岁11个月。2例患儿均以"咳嗽、气促20 d"为主诉入院,病初有一过性低热,于院外分别按照肺炎支原体肺炎、病毒性肺炎治疗,效果不佳。入院查体均可见呼吸促,三凹征(+),口唇、指/趾端发绀,未见杵状指,无啰音。心腹及神经系统查体无异常。均存在低氧血症,二氧化碳分压正常。病原学检查、自身抗体和抗中性粒细胞胞质抗体均为阴性。肺高分辨CT(HRCT)提示双肺透光度减低,以下肺为著,弥散磨玻璃影,实变以及受牵拉的支气管。肺组织病理表现为弥散性肺泡损伤,可见肺泡间隔增厚,肺泡腔内可见纤维样组织。病例1可见透明膜形成。2例患儿均使用糖皮质激素治疗,其中例1应用鼻导管吸氧,例2应用经鼻持续气道正压通气(NCPAP)呼吸支持,均存活,随访2例患儿激素应用逐渐减停,疗程分别为8个月和1年,肺内病变基本吸收。The clinical features,imaging findings and pathological manifestations of children diagnosed with acute interstitial pneumonia(AIP)in the Department of Respiratory,Beijing Children′s Hospital,Capital Medical University from January 2016 to December 2017 were retrospectively analyzed.One patient was a girl aged 8 years and 4 months,and the other patient was a boy aged 1 year and 11 months.Both of them had cough and tachypnea for 20 days with transient afebrile.They were diagnosed as Mycoplasma pneumonia and viral pneumonia,respectively,in other hospitals,but the treatment effect was poor.The physical examination results at admission suggested tachypnea,three depression sign(+),cyanosis of lips and fingers,no acropachia,and no rales.No abnormality in cardio abdominal and nervous system was detected.Both patients had hypoxemia.The partial pressure of carbon dioxide was normal.The investigations of pathogen were negative.Autoantibody and antineutrophil cytoplasmic antibodies were negative.High resolution CT(HRCT)showed reduced light transmittance of both lungs(especially the lower lung),diffuse bilateral ground glass opacities,consolidation,and traction associated bronchiectasis.The pulmonary histopathology showed di-ffuse alveolar damage,thickened alveolar septum and fibrous tissue in the alveolar cavity.The hyaline membrane was observed in the girl patient.Both patients were treated with corticosteroid.The girl patient had nasal cannula oxygenation,while the boy patient received nasal continuous positive airway pressure(NCPAP)support.They were followed up with improvement.The course of corticosteroid was taped for 8 months and 1 year in the girl patient and boy patient,respectively.After treatment,lung lesions were basically absorbed.

关 键 词：间质性肺疾病 弥散肺泡损伤 急性呼吸窘迫综合征 儿童 

分 类 号：R725.6[医药卫生—儿科]