静脉注射口服用硫酸吗啡控释片水溶液致滑石肺1例报告并文献复习

Talcosis associated with intravenous abuse of oral morphine sulfate controlled-release tablets(one case report and literature review)

目的研究静脉注射口服用药物所致滑石肺的临床、影像学和病理特征。方法通过对1例静脉注射口服用硫酸吗啡控释片水溶液致滑石肺患者的临床、影像学和病理资料分析,复习相关文献,总结其特征。结果42岁男性患者,静脉注射口服用硫酸吗啡控释片水溶液2年后出现咳嗽、咳痰,5年后出现胸闷,活动后呼吸困难。体检肺部呼吸音低,血气分析示低氧血症。胸部高分辨CT显示双肺野弥漫性微小结节影及网状影,散在磨玻璃影,双肺小叶中央性肺气肿,以上肺最明显。经纤维支气管镜肺活检组织病理光镜下见肺间质纤维化伴轻度肺泡炎,偏光显微镜下显示肉芽肿内及肺间质中多量针状和不规则晶体物。结论长期静脉注射口服用药物可引起滑石肺,确诊依据肺组织病理偏光查见杆状晶体异物。

Objective To evaluate the clinical, radiologic and pathologic features of talcosis patients associated with intravenous abuse of oral medications. Methods The clinical, radiologic and pathologic data of talcosis patient in the Medical School of Nanjing University associated with intravenous abuse of oral morphine sulfate controlled-release tablets were analyzed retrospectively, and the associated literature was reviewed. Results Oral morphine sulfate controlled-release tablets have been intravenous abused, with the daily dosage of 60 mg/d - 240 mg/d , by a male patient for seven years. Cough and expectoration began to appear after two years successive abuse and the chest distress emerged five years later from the initial abuse. One month prior to admission, exertional dyspnea developed. Physical ex- amination on admission revealed a young man, forty two years old, who was dyspneic even after mild exertion. Cyanosis and acropachy were absent and examination of the chest revealed only decreased breath sounds bilaterally. The blood count, urinalysis, fasting blood glucose,ALT, LDH, AKP, BUN and Cr were within normal limits. CRP was 62. 4 mg/1 and ESR was 75 mm/h. Arterial blood gas determinations revealed that pH was 7. 438 ,PCO2 33.9 mmHg,PO2 64 mmHg,HCO3 - 22. 9 mmol/1. Pulmonary function studies disclosed that FVC was3.94 L （89.7% prediction）, FEV1.0 3.03 L （81.2% prediction）, FEV_1.0/FVC 76.8%, TL_CO 9.89 mmol/min/kPa （ 71.6% prediction）. A chest high resolution computerized tomography at the time of admission showed upper lobe centrilabular emphysema, diffuse fine nodular and reticular opacity and lower lobe ground - glass attenuation focally. Transbronchial lung biopsy was taken after admission and the microscopic study of the lung tissue revealed patchy interstitial fibrosis with a mild alveolitis. Foreign body granuloma with a perivascular distribution were noted. With polarised light, some of these granuloma were seen to contain needle shaped or irregular particles. These particles were also present within the interstitium of the lung focally. Conclusion Taalcosis could be developed after long term intravenous abuse oral medications and final diagnosis depended on polarized light microscopic finding of needle shaped particles in lung tissue.