肺泡微石症3例并文献复习

Pulmonary alveolar microlithiasis： report of three cases and literature review

目的加强对肺泡微石症的认识，提高其诊断率。方法通过中国生物医学文献光盘数据库（CBM-Disk）检索1994年1月至2010年5月有关报道肺泡微石症的文献，剔除重复累计报道病例，结合本院收治的3例，回顾性分析中国人肺泡微石症的临床资料。结果共报道了120例肺泡微石症，男70例（58．3％），女50例（41．7％）。有临床症状者65例，主要表现为咳嗽51例（42．5％）、气促49例（40．8％）、咯痰26例（21．7％）、胸痛18例（15．0％）、胸闷17例（14．2％）、心悸4例（3．3％）、咯血3例（2．5％）。无症状者55例。啼功能检查22例，7例正常，12例呈限制性通气功能障碍，弥散功能下降。120例均行胸部X线检查，显示双肺粟粒影106例，其中92例中下肺粟粒影增加，病灶聚集融合41例，肺门正常104例，心膈模糊55例，线状钙化48例，肺尖气肿1例。结论我国肺泡微石症较为少见，临床症状无特异性，易漏诊、误诊。对可疑患者应及早行胸部高分辨率CT及纤维支气管镜肺活检以确诊。

Objective To describe the clinical feature of pulmonary alveolar microlithiasis （PAM） and heighten the ratio of diagnosis. Methods Three cases of PAM from this hospital were presented. The literatures related to PAM were searched through Chinese Biomedical Disk, and the data of all the cases were retrospectively analyzed. Results A total of 120 cases were collected, including 70 male and 50 female patients. The main clinical manifestations included cough （n = 51 ）, dyspnea （n = 49）, expectoration （ n =26）, chest pain （ n =18）, chest distress （ n = 17）, palpitation （ n =4）, hemoptysis （ n = 3）. Pulmonary function test showed normal findings in 7 cases, restrictive ventilatory disorder and decreased diffusing capacity for carbon monoxide in 12 cases. Chest X-ray was performed in 120 cases. Profusion of micro nodules were present in 106 cases, normal hilum in 104 cases, pericar dialseptum vague in 55 cases, linear suhpleural calcification in 48 cases, and apex pulmonis emphysema in one case. Conelusion： As an uncommon disease, PAM is often underdiagnosed and misdiagnosed. High resolution computerized tomography and fibro bronchoscopy are helpful for confirmation of the diagnosis.