过敏性肺炎临床特征分析

Analysis of clinical features of hypersensitivity pneumonitis

目的分析过敏性肺炎的临床特征，以降低误诊率，提高治疗针对性。方法选择2011年2月至2015年12月过敏性肺炎患者60例，依据是否经组织病理确诊，将其分为病理组和临床纽，每组30例。总结两组临床特征及误诊状况。结果病理组以接触化学物质占比最高，有14例（46．67％）；临床组以接触动物蛋白占比最高，有16例（53．33％），两组暴露因素方面比较差异有统计学意义（x2=13．774，P=0．000）。病理组影像学特点以慢性为主，有18例，占60．00％。临床组影像学特点以急性为主，有22例，占73．33％。两组影像学表现方面比较差异有统计学意义（x2=6．787，P=0．009）。病理组淋巴细胞〈0．2的例数与临床组比较差异未见统计学意义，但是CD4／CD8〈0．9的例数与临床组比较差异有统计学意义（x2=5．454，P=0．019）。内科和外科肺活检结果临床诊断价值较低，过敏性肺炎的误诊率较高。结论在现有的技术水平下，诊断过敏性肺炎客观上存在诸多的限制。当症状不典型时，需结合病理检查，以提高确诊率。

Objective To analyze the clinical features of hypersensitivity pneumonitis, and thus to reduce the rate of misdiagnosis and increase the pertinence. Methods From February 2011 to December 2015, 60 patients with hypersensitivity pneumonitis were selected and were divided into pathology group and clinical group, with 30 cases in each group, according to whether through the organization. The clinical characteristics and misdiagnosis of the two groups were summarized. Results In the pathology group, the propotion of exposure to chemical substances was the highest （14 cases, 46.67% ） ; in the clinical group, the proportion of exposure to animal protein was the highest （16 cases, 53.33% ）, there was significant difference in the exposure factors between the two groups （X2 = 13.774, P =0. 000）. In the pathology group, chronic imaging features took the highest proportion, there were 18 cases, accounting for 60. 00%. Clinical group mainly with acute imaging features, there were 22 cases, accounting for 73.33%. Imaging performance of the two groups were significantly different （ X2 = 6. 787, P = 0. 009）. The number of pathological lymphocyte 〈 0. 2 had no significant difference compared with the clinical group, but the number of CD4/CDs 〈 0. 9 had significantly difference between the two groups （X2 = 5.454,P = 0. 019）. The diagnosis value of medical and surgical lung biopsy was low, the misdiagnosis rate of hypersensitivity pneumonitis was high. Conclusions Under current level of technology, diagnostic hypersensitivity pneumonitis objectively, there are many restrictions. When the symptoms are not typical, pathological examination should be combined to improve the diagnosis rate and conduct timely treatment.