外源性过敏性肺泡炎3例并文献复习

Extrinsic allergic alveolitis:three cases report and literature review

目的分析外源性过敏性肺泡炎(EAA)的临床特点,提高对EAA的诊断和治疗能力。方法回顾性分析我院3例EAA患者的临床资料,分析和讨论EAA的发病机制、临床表现、诊断、治疗及预后等。结果 3例患者中1例有明确的过敏原接触史,其余2例为较隐匿的间接接触史。临床症状主要有咳嗽、咳痰、发热和喘憋,其中1例为急性起病,其余2例为慢性起病。肺部高分辨CT主要表现为索条影、弥漫性斑片状或磨玻璃样影等。其中1例支气管肺泡灌洗液CD4/CD8为4.13,其余2例分别为0.72和0.84。3例患者经治疗后症状均缓解。结论 EAA患者临床表现、严重程度和自然病史差异性很大,起病缓急不一。当临床表现不典型,暴露因素不明确时需临床医师高度的识别能力。

Objective To improve the ability of diagnosis and treatment of patients with extrinsic allergic alveolitis（EAA）upon the analysis of its clinical features.Methods We retrospectively analyzed the clinical data of three patients with EAA in our hospital,including pathogenesis,clinical manifestation,diagnosis,treatment and prognosis evaluation.Results One case had a clear allergen exposure history,the remaining two cases had the hidden history of indirect contact.Clinical symptoms mainly contained cough,sputum,fever,and wheezing.One patient had acute onset,and the other two cases had chronic onset.High-resolution CT lung manifestation mainly contained streaks shadow,diffuse or patchy ground-glass opacities and so on,the CD4/CD8 in the bronchoalveolar lavage fluid of one patient was 4.13,while that in the remaining two cases was 0.72 and 0.84.Three patients were alleviated in symptoms after treatment.Conclusion The clinical manifestation,severity and natural history of patients with EAA have a variety of performances.Clinicians need high recognised ability especially when patients have atypical clinical manifestations or the exposure factors of patients are not clear.