胺碘酮的肺毒性六例报告

The pulmonary toxicity of amiodarone: six-case report

目的 报告胺碘酮肺毒性的临床特点、诊断与处理方法、预后以及早期发现措施。方法 回顾性总结分析 6例胺碘酮引起肺毒性作用患者的临床经过、X线、CT表现及治疗转归。结果男性 5例 ,女性 1例 ;年龄 6 2～ 6 9(6 6 0± 2 4 )岁 ;5例因阵发性心房颤动 ,1例因室性心律失常服用胺碘酮 ;胺碘酮负荷量 7g ,维持量≤ 0 2 g/d。从服药开始至发现肺毒性的时间为 0 5～ 4 (2 1± 1 3)年。例 1表现为呼吸困难、两下肺可闻爆裂音 ,X线胸片示两下肺网格样改变 ;其余 5例无明确临床症状 ,均在常规随诊、复查X线胸片时发现肺纹理较前增重或紊乱 ,高分辨CT示肺间质改变而明确诊断。呼吸功能检查 :例 1示限制性通气障碍、CO弥散功能下降 ;其余 5例弥散功能正常 ;例 6示阻塞性通气功能障碍。诊断肺间质病变后 ,均停用胺碘酮。 1例服用泼尼松 ,3例服用阿奇霉素 ,2例未行药物治疗。随访 0 1～ 5 0年 ,例 1症状明显减轻 ,其余患者未新出现呼吸系统症状 ,X线胸片无变化。结论 肺毒性是胺碘酮的严重毒副作用 ,典型表现为肺间质纤维化 ,早期表现为肺间质增厚 ,激素治疗有效。定期检查X线胸片并对可疑病例行CT检查有利于早期诊断。早期诊断病例预后较好。

Objective To report the clinical features and the prognosis, the methods of diagnosis and treatment, and the early detection of the pulmonary toxicity induced by amiodarone. Method The clinical course, the findings of X-ray and CT and the results of treatment were summarized and analyzed in six patients with amiodarone-induced pulmonary toxicity. Results Five males, one female, aged 62-69(66.0±2.4) years . Amiodarone was used because of paroxysmal atrial fibrillation in five patients and ventricular arrhythmia in one. The loading dose was 7 g and the maintaining dose was 0.2 g/d or less. Pulmonary toxicity was recognized at the times in 0.5-4.0(2.1±1.3) years after amiodarone therapy. Dyspnea occurred, crack rales were audible in both lower parts of the lungs, and the chest X-ray showed grid-like changes in case one. No symptom was found in the others. Their diagnosis was made according to the pulmonary intestinal changes by high-resolution computerized tomography when the lung marking was increased or deranged by chest X-ray during the regular follow-up. Pulmonary function examination showed that the restrictive ventilation and the CO diffusing capacity decreased in case one, while the CO diffusing capacity was normal in the others. The decreased obstructive ventilation capacity was found in case six. Amiodarone was discontinued in all the cases after the diagnosis of induced pulmonary toxicity. One patient was treated with corticosteroid , three with azithromycin,and the another two patients were not treated with drug. During 0.1-5.0 year period of follow-up the symptoms were markedly attenuated in case one, and no new symptoms and radiography findings were found in the others. Conclusions Pulmonary toxicity is a serious adverse effect of amiodarone. The typical feature is pulmonary intestinal fibrosis and thick pulmonary intestine in the early stage. Corticosteroid treatment seems effective. It would be helpful for early diagnosis to take chest X-ray examination regularly and CT examination in suspicions cases during the therapy. The prognosis may be good in the early diagnosed cases.