肺淋巴瘤样肉芽肿病伴肺结核及人类免疫缺陷病毒感染一例并文献复习  

Pulmonary lymphomatoid granulomatosis with tuberculosis and HIV infection:a case report and literature review

作　　者：华少鹏 胡小芳 赵新国 毛佳 HUA Shaopeng;HU Xiaofang;ZHAO Xinguo;MAO Jia(Department of Tuberculosis,Wuxi Fifth People's Hospital,Wuxi,Jiangsu 214007,P.R.China;Department of Emergency,The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University,Wuxi,Jiangsu 214001,P.R.China)

机构地区：[1]无锡市第五人民医院结核科,江苏无锡214007 [2]南京医科大学附属无锡第二医院急诊科,江苏无锡214001

出　　处：《中国呼吸与危重监护杂志》2023年第5期326-331,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨肺淋巴瘤样肉芽肿病的临床特点及诊疗方案,加深对肺淋巴瘤样肉芽肿病的认识。方法报告1例合并肺结核及人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染的肺淋巴瘤样肉芽肿病。以“pulmonary,lung,lymphomatoid granulomatosis”为检索词检索PubMed数据库,以“肺,淋巴瘤样肉芽肿病”为检索词检索中国知网、万方数据库,检索时限均为2017年1月1日—2021年12月31日。结果本例患者病初明确诊断为肺结核,经正规抗结核治疗后病灶明显吸收好转,抗结核治疗半年后复查胸部CT示双肺新增多发类圆形结节影;加强抗结核治疗无改善,进一步肺穿刺活检,病理提示淋巴瘤样肉芽肿病,2级;期间发现HIV感染,患者经抗病毒感染后复查胸部CT肺部病灶明显吸收好转。文献复习纳入47例患者,加上本例,合计48例。其中男26例(54.2%),女22例(45.8%),中位年龄60岁(4~87岁);最常见的症状为咳嗽、发热、气促,另外可伴有乏力、体重下降、盗汗、食欲下降;20.9%的患者查体可见皮疹,主要表现为皮肤红斑或丘疹;39.6%患者伴有免疫系统相关疾病或免疫抑制剂使用;胸部CT最多见的表现为双肺累及的多发结节影或肿块影;确诊途径主要通过手术肺活检,也可通过CT引导下肺穿刺活检,经气管镜活检阳性率低;病理分级以3级为主(56.3%);治疗方案主要为R-CHOP方案,有效率71.4%,对于考虑药物诱导发病的患者需首先停用诱导药物,如无改善再联合化疗,对于合并HIV感染者,先予高效抗逆转录病毒治疗,如无改善再联合化疗;48例患者中,共有41例患者有明确随访结果,中位随访时间12个月,其中死亡14例(34.1%),其余均有不同程度好转。结论肺淋巴瘤样肉芽肿病是一种少见病,临床医师需提高对其认识,争取早期识别该疾病,并选择合适的治疗方案以改善其预后。Objective To explore the clinical characteristics,diagnosis and treatment plan of pulmonary lymphomatoid granulomatosis in order to deepen the understanding of this disease.Methods A case of pulmonary lymphomatoid granulomatosis complicated with tuberculosis and human immunodeficiency virus(HIV)infection was reported.Literature reviews were searched in PubMed database with"pulmonary,lung,lymphomatoid granulomatosis"as the key words,and in China Knowledge Network and Wanfang database with"lung,lymphomatoid granulomatosis"as the key words.The search time was from January 1,2017 to December 31,2021.Results The patient was diagnosed as pulmonary tuberculosis at the beginning of the disease,and the lesion was obviously absorbed and improved after regular anti-tuberculosis treatment.Six months after anti-tuberculosis treatment,chest CT examination showed multiple new circular nodules in both lungs.Intensive anti-tuberculosis treatment did not improve,further lung biopsy,pathology revealed lymphomatoid granulomatosis,grade 2;During the period,HIV infection was proven,and the patient underwent anti-viral infection and re-examination of chest CT lung lesions significantly improved absorption.Literature reviews found 47 same patients,therefore totally 48 patients were analyzed,in which this former case was included.Among the 48 patients,26 were male(54.2%)and 22 were female(45.8%),with a median age of 60 years old(4 to 87 years old).The most common symptoms were cough,fever and shortness of breath,some of them may be accompanied with fatigue,weight loss,night sweats and loss of appetite.20.9%of the patients had rashes,mainly manifested as erythema or papules.39.6%of the patients were accompanied by immune system related diseases or immunosuppressants;The most common manifestations of chest CT were multiple nodules or masses involving both lungs.The main way of diagnosis was surgical lung biopsy,or CT-guided lung puncture biopsy.The positive rate of bronchoscopy biopsy was low.The pathological grade was mainly grade 3(56.3%

关 键 词：肺 淋巴瘤样肉芽肿病 HIV 临床特征 治疗方案 

分 类 号：R734.2[医药卫生—肿瘤] R521[医药卫生—临床医学] R512.91