14例慢性嗜酸性粒细胞肺炎患者临床特征分析  

Clinical characteristics of 14 patients with chronic eosinophilic pneumonia

作　　者：肖迎 任思颖[1] 彭红[1] Xiao Ying;Ren Siying;Peng Hong(Department of Respiratory and Critical Care Medicine,Xiangya Second Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院呼吸与危重症医学科,长沙410011

出　　处：《中国医师杂志》2021年第8期1128-1132,共5页Journal of Chinese Physician

基　　金：国家自然科学基金(81700070);国家临床重点专科建设项目;湖南省自然科学基金(2019JJ30038);湖南省卫生计生委科研项目(B2018-0541)。

摘　　要：目的总结慢性嗜酸性粒细胞肺炎(CEP)患者的临床特征,为临床医生提供参考,提高诊治水平。方法回顾性分析2012年1月至2021年7月于中南大学湘雅二医院住院治疗的CEP患者14例,分析其临床表现、实验室检查、影像学特点及诊疗经过。结果14例CEP患者男女比例为6:1,中位年龄51岁,3例患者有过敏性鼻炎、鼻窦炎、皮疹等过敏病史。患者中位病程4个月,常见症状包括咳嗽(14例)、咳痰(13例)、气促(10例)等,偶有皮疹、淋巴结肿大等胸外症状(2例)。8例患者出现肺部听诊异常,主要为双肺呼吸音粗及散在的干湿性罗音。所有患者均可见外周血嗜酸性粒细胞数(EOS)升高,中位血EOS计数为1.42×10^(9)/L。11例患者出现血清总IgE升高,其中10例>1000 ng/ml。11例患者进行了肺功能检查,5例肺功能正常,3例阻塞性通气功能障碍,3例限制性通气功能障碍。14例患者均进行了肺部CT检查,大部分(13例)为双肺浸润,病变征象主要表现为斑片影(6例)、磨玻璃影(4例)、网格影(3例)和实变影(3例)等,部分可见散在分布的结节影(3例);6例患者出现纵隔或肺门淋巴结肿大。9例患者行支气管镜下肺泡灌洗术(BAL)并进行细胞分类及计数,仅3例EOS计数高于正常值(正常值<3%)。10例患者进行支气管镜下肺活检,6例出现肺组织内EOS浸润。9例患者进行了糖皮质激素治疗,口服皮质类固醇激素(OCS)(泼尼松或甲泼尼龙)治疗者8例,初始剂量为30〜50 mg;单纯布地奈德雾化治疗者1例;5例患者临床诊断时未确诊CEP,仅使用抗生素或其他对症治疗,未使用激素。结论CEP为罕见的肺部疾病,临床表现缺乏特异性,常见症状为咳嗽、咳痰、气促等,容易误诊。实验室检查常提示外周血EOS计数及总IgE升高,影像学主要表现为双肺弥漫性浸润影,可有淋巴结肿大。口服OCS治疗是CEP的一线治疗方法,治疗后短期预后良好,但易复发,一些新型的单克隆�Objective To summarize the clinical characteristics of patients with chronic eosinophilic pneumonia(CEP),so as to provide reference for clinicians and improve the level of diagnosis and treatment.Methods 14 patients who met the diagnostic criteria of CEP in Xiangya Second Hospital of Central South University from January 2012 to July 2021 were analyzed retrospectively.Their clinical manifestations,laboratory examination,imaging characteristics,diagnosis and treatment were analyzed.Results The male to female ratio of 14 patients with CEP was 6:1,with a median age of 51 years.3 patients had allergic rhinitis,sinusitis,rash and other allergic history.The course of the disease was about 4 months.The common symptoms included cough(14 cases),expectoration(13 cases),shortness of breath(10 cases),and occasional extrathoracic symptoms such as rash and lymphadenopathy(2 cases).Eight patients had abnormal pulmonary auscultation,mainly coarse respiratory sounds of both lungs and scattered dry and wet rales.The eosinophil count(EOS)in peripheral blood was increased in all patients,and the median EOS count was about 1.42×10^(9),/L.Total serum IgE increased in 11 patients,of which 10 cases were more than 1000 ng/ml.Pulmonary function tests were performed in 11 patients,including 5 cases of normal pulmonary function,3 cases of obstructive ventilation dysfunction and 3 cases of restrictive ventilation dysfunction.All 14 patients underwent lung computer tomography(CT)examination.Most of them(13 cases)were douijle lung infiltration.The pathological signs were mainly patch shadow(6 cases),ground glass shadow(4 cases),grid shadow(3 cases)and consolidation shadow(3 cases),and scattered nodule shadow(3 cases)was seen in some cases;Mediastinal or hilar lymphadenopathy occurred in 6 patients.9 patients underwent bronc-hoscopic alveolar lavage(BAL)and cell classification and counting.Only 3 cases had EOS counts higher than the normal value(normal value<3%).10 patients underwent bronchoscopic lung biopsy,and 6 patients had EOS infiltratio

关 键 词：肺炎 肺嗜酸粒细胞增多 抗体 单克隆 皮质类固醇 

分 类 号：R563.1[医药卫生—呼吸系统]