以双肺肺大泡为肺部影像学表现的干燥综合征1例报告及文献复习

Sjogren's syndrome with pulmonary bullae in both lungs as lung imaging performance:A case report and literature review

目的:探讨以双肺肺大泡为肺部影像学表现的干燥综合征(SS)的临床特点,分析SS累及肺部的常见影像学表现,提高临床医生对SS患者常见胸部影像学表现的认识。方法:收集1例以双肺肺大泡为肺部影像学表现的SS患者的临床资料、支气管镜和病理检查结果,并进行相关文献复习。结果:患者,青年女性,以呼吸困难、咳血为首发症状入院。查体可见猖獗齿,无其余明显阳性体征。胸部CT显示双肺肺大泡,行风湿系列、角膜染色、唇腺活检及其他相关检查,并给予相关治疗。患者血清免疫学提示抗SSA、抗SSB和类风湿因子阳性,角膜染色(+),下唇腺病理示每灶淋巴细胞数≥50个,最终临床诊断为SS。给予糖皮质激素和环磷酰胺治疗。治疗后患者症状好转,出院继续口服糖皮质激素和环磷酰胺,治疗2个月后复查胸部CT示双肺肺大泡未见明显变化。结论:SS作为一种结缔组织病,其临床表现多样,累及肺部时,肺部的影像学表现也各不相同。当患者胸部CT提示存在双肺不明原因的多发肺大泡时,应考虑SS的可能,做到早发现、早治疗,避免漏诊、误诊及延误病情。

Objective:To explore the clinical characteristics of Sjogren’s syndrome(SS)with pulmonary bullae in both lungs as lung imaging performance,to analyze the common lung imaging performance of SS,and to impove the clinicians’ understanding of the common lung imaging performace of the SS patients.Methods:The clinical materials,the results of bronchoscope and pathological examination of a SS patient with pulmonary bullae in both lungs as lung imaging performance were collected,and the relative literatures were reviewed.Results:A young female patient with dyspnea and hemoptysis as the chief complaint was permitted to the hospital.The physical examination results showed rampant tooth and there were no other obvious positive signs.The chest CT results showed the pulmonary bullae in both lungs.Further rheumatism examinations,corneal staining,labial gland biopsy and other assistant examinations were performed,and the patient received the related treatment.The serum immunological results indicated anti-SSA,anti-SSB,and corneal staining(+),and the rheumatoid factors were all positive;the pathology of the lower labial gland biopsy showed the number of lymphocytes in each lesion≥50;the patient was diagnosed as SS finally.The patient was treated with glucocorticoids and cyclophosphamide.After the treatment,the symptoms of the patient were improved.After discharged from the hospital,the patient was treated with glucocorticoids and cyclophosphamide continuously for 2 months.However,reviewing of chest CT showed no significant changes in the lung bullae in both lungs.Conclusion:SS is a connective tissue disease with diverse clinical manifestations.When the lungs are involved,the lung imaging performance also presents no specificity.When the patient’s chest CT indicates the presence of multiple pulmonary bullae in both lungs,and no causes are find out,the possibility of SS should be considered;so that early detection and early treatment should be performed,and misdiagnosis and delay treatment of illness can be avoided.