非特异性间质性肺炎三例报告并文献复习

A retrospective study of 3 cases of nonspecific interstitial pneumonia

目的 探讨非特异性间质性肺炎 (NSIP)的临床特点。方法 回顾性分析 3例病理学诊断的NSIP的临床表现、影像学、生理学及支气管镜检查的特点。结果 3例病人 ,2女 1男 ,平均年龄4 9～ 5 9岁 ,就诊时病程 3～ 7个月。 3例病人均有咳嗽、进行性呼吸困难和吸气相爆裂音 ,其中 2例有间断低热但无 1例有杵状指。 1例病人发病前曾接触有机粉尘 ,另 1例经查有原发性干燥综合征。胸部高分辨CT(HRCT)均以片状磨玻璃样变为主要表现 ,伴有支气管血管纹理增厚 ,2例有小片状实变影 ,1例有牵引性支气管扩张 ,未见蜂窝样变。支气管肺泡灌洗液 (BALF)检查见细胞总数与淋巴细胞比例均升高。 2例病人进行了BALF的T细胞亚群分析 ,结果CD4/CD8比例均明显倒置。结论 NSIP在临床上有许多特点异于UIP ,并可能有提示诊断作用。

Objective To discuss the clinical features of nonspecific interstitial pneumonia. Method Review of three cases of pathologically proved NSIP with the clinical, radiological, physical and bronchoscopic presentation. Results Three cases, one male and two females, aged from 49 to 59, presented with a duration of symptoms on diagnosis of 3 to 7 months.Cough ,worsening dyspnea and inspiratory crackles were presented in all three cases and intermittent low grade fever in two but none has digital clubbing.There was a history of organic dust exposure in one case and in another case primary Sjgren′s syndrome was diagnosed.Patchy ground glass attenuation with thickening of bronchovascular markings were the main findings in high resolusion computed tomography (HRCT) of all three cases.Small areas of consolidation in two cases and traction bronchiectasis in one were found while there was no honeycombing.Increased bronchoalveolar lavage fluid (BALF) cell recovery and percentage of lymphocytes were found in all cases. The BALF CD 4/CD 8 ratio was measured in two cases and was markedly decreased in both cases. Conclusion NSIP has some clinical features that are different from UIP and may provide clues to diagnosis.