28例儿童肺部弥漫性疾病的病因和诊断分析  

Causes and diagnostic procedure of diffuse lung disease in 28 children

作　　者：赵顺英[1] 江载芳[1] 任甄华[2] 

机构地区：[1]首都医科大学附属北京儿童医院内科,100045 [2]首都医科大学附属北京儿童医院放射科,100045

出　　处：《中华儿科杂志》2003年第7期542-545,共4页Chinese Journal of Pediatrics

摘　　要：目的　探讨儿童肺部弥漫性疾病的病因和诊断思路。方法　回顾性分析 2 8例肺部弥漫性疾病患儿的诊断以及确诊过程。结果　确定病因 2 5例 ,包括支原体肺炎 1例、沙眼衣原体肺炎2例、巨细胞病毒肺炎 2例、EB病毒肺炎 1例、血型播散性肺结核 3例、金黄色葡萄球菌败血症性肺炎1例、肺隐球菌病 1例、侵袭性肺曲霉菌病 2例、广泛支气管扩张合并肺部感染 2例、特发性肺含铁血黄素沉着症 1例、特发性肺纤维化 1例、HIV合并淋巴细胞间质性肺炎 1例、鸽粪引起的外源性变应性肺泡炎 1例、韦格内肉芽肿 1例、郎格罕细胞组织细胞增生症 2例、恶性淋巴瘤 3例。疑似诊断 3例 ,包括奴卡菌感染 1例、少年类风湿性关节炎合并肺纤维化 1例、HIV合并卡氏肺囊虫 1例。 18患儿经X线检查、病史和体格检查以及其他非创伤性检查诊断 ,8例经皮肤活检或肺活检诊断 ,2例由尸解确诊。结论　儿童肺部弥漫性疾病的病因包括肺部感染性疾病、特发性疾病和全身疾病的肺部表现。影像学表现、病史和体格检查以及其他非创伤性检查能确定多数患儿的病因 。Objective Diffuse lung disease comprises a large, heterogeneous group of pulmonary interstitial and parenchymal disease. It is therefore difficult to some extent to make etiologic diagnosis. Little information on clinical spectrum and diagnostic evaluation of pediatric diffuse lung disease is available in our country. The purpose of this study was to explore the causes of and diagnostic approach to diffuse lung disease in children. Methods Twenty-eight children with diffuse lung disease aged 2 months to 14 years were studied retrospectively. Their history, physical examination, radiographic findings, final diagnosis and diagnostic processes were reviewed. Results Confirmed diagnosis was established in 25 cases and suggestive diagnosis in 3 cases. Confirmed diagnoses included: mycoplasma pneumonia in 1 case, Chlamydia trachomatis pneumonia in 2 cases, Epstein-Barr virus pneumonia in 1, CMV pneumonia in 2, hematogenous disseminated pulmonary tuberculosis in 3, pulmonary cryptococcosis in 1, invasive pulmonary aspergillosis in 2, Staphylococcus aureus sepsis in 1, diffuse bronchiectasis in 2, idiopathic pulmonary hemosiderosis in 1, idiopathic pulmonary fibrosis in 1, extrinsic allergic alveolitis in 1, HIV-related lymphocytic interstitial pneumonitis in 1, Wegner′s granulomatosis in 1, Langerhan′s cell histiocytosis in 2, and lymphoma in 3. Suggestive diagnoses included Nocardia pneumonia in 1, Pneumocystis carinii pneumonia in 1, and juvenile rheumatoid arthritis-associated pulmonary fibrosis in 1. The diagnostic directions of 26 patients were conducted by radiographic features. In 17 of 26 cases, the diagnostic range was confined by history. The diagnosis of 14 cases was made by noninvasive tests including antibody detection, bacterial culture, those of 8 cases by examination of biopsy material, and those of 2 cases by autopsy. Conclusions The causes of pediatric diffuse lung disease included pulmonary infectious disease, idiopathic pulmonary disease and pulmonary lesion associated with systemic diseases

关 键 词：儿童 肺部弥漫性疾病 病因 诊断 金黄色葡萄球菌败血症性肺炎 

分 类 号：R725.6[医药卫生—儿科]