外源性过敏性肺泡炎14例临床分析

Clinical analysis of extrinsic allergic alveolitis in 14 patients

目的探讨外源性过敏性肺泡炎的临床特征及防治手段。方法分析湖北省宜都市第一人民医院呼吸内科2003年收治的14例外源性过敏性肺泡炎患者的临床表现、影像学及流行病学特点。结果14例患者发病前均有职业环境接触史,发热、咳嗽、咳痰、呼吸困难、肺部干性及湿性啰音是主要的症状和体征?喂δ芟允鞠拗?性通气功能障碍4例(28.6%)。血气分析显示低氧血症4例(28.6%)。肺部CT表现为双中下肺野改变12例(85.7%),其中9例(64.3%)双肺见斑片状磨玻璃影,1例(7.1%)伴有局限性的肺气肿,2例(14.3%)左上肺野出现网格状条索影。14例患者支气管肺泡灌洗液中淋巴细胞占细胞总数的比例增高(>20%),CD4/CD8平均值为0.64±0.21,IgM、IgG阳性13例(92.9%)。10例患者给予糖皮质激素治疗,4例患者给予抗感染治疗,30～40d后复查CT显示12例(85.7%)患者肺部阴影完全消失,2例(14.3%)患者肺部阴影部分吸收。结论外源性过敏性肺泡炎的临床特征、影像学改变、肺功能及免疫学检查无特异性,支气管肺泡灌洗液检查对其诊断有较高的价值。避免接触过敏原是治疗的关键,糖皮质激素疗效明显。

Objective To approach the clinical features and the methods of preventing extrinsic allergic alveolitis. Methods We reported the extrinsic allergic alveolitis in 14 patients from 2003, and analysed the clinical manifestation, mageology as well as the characteristics of the epidemiology. Results Fourteen patients had the history of exposure to work environment before morbidity. There were many symptoms and clinical signs, which included fever, cough, expectoreation, dyspnia, bruit de craquement and moist rale. Restrictive ventilatory impairment was the frequent functional pattern （4/ 14）. Four patients（28.6% ）hypoxemia when blood gas analysis was performed. The most frequent radiologic finding was an interstitial pattern in 85.7% of patients. High resolution chest CT（HRCT） features were ground glass areas （64. 3% ） and a mosaic pattern（ 14. 3% ）. Areas of emphysema were found in lpatient （7.1%）. Lymphocytosis （ 〉 20% lymphocytes） was documented in all patients who underwent bronchoalveolar lavage （BAL）. In addition, inversion of the CD4/ CD8 ratio（ mean value ：0. 64 ±0. 21 ）was observed in the patients. Non-specific IgM and IgG antibodies to antigens were documented in 13/14（92. 9% ）of BAL patients. Ten patients were cured by glucocorticoid,other by anti-infective therapy. We rechecked the HRCT which displayed the shade of lung in 12 patients（ 85.7% ）vanishing completely,2 patients＇ （ 14. 3 % ）partly. Conclusion There is no specificity in the clinical manifestations, change of mageology, pulmonary function and the immunologic test. However, compared with other methods, we find the test of BAL is more valuable to the diagnosis. It is critical to avoid the antigen, and we find the curative effect of the glucocorticoid is significant.