复发性过敏性肺炎的误诊分析及文献复习

Misdiagnosis of Relapsing Hypersensitivity Pneumonitis:A Case Report and Literature Review

目的探讨过敏性肺炎的临床特点和误诊原因,提高临床医师对过敏性肺炎的诊治水平,减少复发。方法回顾性分析广州呼吸疾病研究所诊治的1例过敏性肺炎的发病、误诊、进展、治疗、痊愈、复发等过程,结合文献,着重阐述过敏性肺炎的病因、发生机制、临床特征、误诊原因及治疗体会。结果过敏性肺炎多有抗原性有机粉尘及化学物质接触史,临床症状无特异性,胸部影像学表现为"游走性"的多发网格状或斑片状浸润影,肺功能检查示限制性通气功能障碍和弥散功能下降,血嗜酸粒细胞不高,血清IgG沉淀抗体、支气管肺泡灌洗液淋巴细胞不一定异常;病理组织学的改变复杂,急性到慢性病例表现为从急性炎症到慢性纤维化的渐进过程。治疗应尽快给予全身糖皮质激素,同时应定期随访,反复强调避免接触抗原的重要性,预防复发。结论过敏性肺炎因症状表现不典型,临床中容易误诊,应结合接触史、临床特点、影像学表现、实验室检查、活检病理等方面确诊,及时治疗。

Objective To investigate the clinical features of hypersensitivity pneumonitis and misdiagnosis causes. Methods The morbidity, misdiagnosis, progression, treatment, recovery, relapse and experience of treatment of a case with hypersensitivity pneumonitis was retrospectively analyzed. Results Patients with hypersensitivity pneumonitis usually have a contact history of organic dust, and clinical manifestations are nonspecific. Chest radiography shows wandering pattern of multiple reticular or patchy infiltration shadows. Lung function tests show restricted ventilation and impaired diffusion. Blood eosinophi] is usually normal. Lymphocyte and sedimentation antibody in serum and bronchoalveolar lavage fluid may still be normal. Pathohistology is complicated, with a progression from acute inflammation to chronic fibrosis. Systemic steroid should be prescribed as soon as possible. Antigen avoidance should be emphasized. Conclusions Clinical symptoms of hypersensitivity pneumonitis is atypical, which may be easily misdiagnosed. The contact history, clinical features, chest radiography, laboratory examination and pathological changes should all be considered in such cases.