慢性嗜酸性粒细胞肺炎一例报告并文献复习

Chronic eosinophilic pneumonia: case report and review of literature

目的介绍1例慢性嗜酸性粒细胞肺炎(CEP)并复习近10年17篇文献共125例,以期提高对这一少见病的认识。方法对1例经胸壁肺活检病理确诊为CEP患者的临床及随诊资料进行分析,并结合文献讨论其临床特点、诊断及治疗等。结果CEP是一种病因不明的慢性肺嗜酸性粒细胞性炎症。其特点为患者多有过敏性疾病史;临床表现除咳嗽、咳痰外,常有呼吸困难及喘息;外周血嗜酸性粒细胞明显增高;胸部X线片呈肺外周非肺段分布性进展性高密度浸润影,常有“肺水肿反向征”;痰和(或)支气管肺泡灌洗液嗜酸性粒细胞显著增高;抗感染治疗无效而对口服糖皮质激素(OCST)反应良好,OSCT治疗后阴影迅速吸收,但同一部位可多次复发。病理显示肺间质、支气管黏膜下嗜酸性粒细胞浸润及肺泡腔内大量嗜酸性粒细胞渗出。CEP虽易复发,但总的预后良好。结论对具有以上特征且抗生素治疗无效的肺炎患者,应疑及CEP,及时行支气管肺泡灌洗嗜酸性粒细胞计数或肺组织活检可明确诊断。大部分患者需长期维持量OCST治疗。

Objective To highlight the characteristics of chronic eosinophilic pneumonia（CEP） with combination of practical experience and review of literatures. Methods One patient with CEP confirmed by thoraco- scopie biopsy was described and the relevant literatures were reviewed. Results CEP is a rare disorder of unknown etiology which is characterized by peripheral blood eosinophilia, peripheral pulmonary infiltrates and dramatic response to corticosteroid therapy, but relapses are frequent on reduction or ceasation of the very treatment. CEP has a good prognosis. Conclusions CEP is a rare disease and should be included in the differential diagnosis of fever, dyspnea and peripheral infiltrates on the chest film. Thoracoscopic biopsy and/or BALF would be helpful for diagnosis. Majority of the patients require long-term OCST therapy. （Shanghai Med J, 2005,28： 1010-1013）