弥漫性肺疾病70例临床报道

Clinical report of diffuse parenchymal lung disease:70 cases

目的 分析十堰地区2015~2018年弥漫性肺疾病(DPLD)的诊断与治疗情况。方法 回顾性选取2015年1月~2018年12月在十堰市太和医院住院治疗的70例DPLD患者,年龄20~79岁,平均(52.59±14.61)岁。分析其临床、影像、病理检查等结果与治疗情况。结果 70例DPLD中非特异性间质性肺炎是主要病理类型。患者临床表现以咳嗽、活动后呼吸困难、进行性气短、发热等为主,体征主要表现为发钳、肺部闻及Velcro啰音、湿罗音等;胸部X射线检查以网状影、斑片影、结节状阴影较常见,且以弥散分布为主,累及双侧肺野;胸部CT检查结果显示,病灶累及双侧肺野,以双侧中下肺为主,以斑片状影、网格状影、胸膜肥厚为主;血常规检查以血沉升高、中性粒细胞计数升高、C反应蛋白升高为主。70例患者中有48例接受肺功能检查,83.33%(40/48)的患者检出限制性通气功能障碍。病理检查前有23例接受抗感染治疗,14例接受糖皮质激素治疗。病理确诊后,60例接受抗感染治疗,使用激素者40例,抗感染联合激素治疗者34例,抗感染、激素联合免疫抑制剂者7例。70例患者中无放弃治疗者,在治疗1个月内死亡1例。结论 DPLD好发于中老年人群,以进行性加重的呼吸困难、咳嗽为主要症状,肺部可闻及Velcro啰音,疾病多为明确病因的DPLD,糖皮质激素或(和)免疫抑制剂是其主要治疗手段,患者一般预后良好,死亡率低。

Objective To explore the diagnosis and treatment of diffuse parenchymal lung disease(DPLD)in Shiyan area from 2015 to 2018.Methods The retrospective analysis was adopted.70 cases of DPLD patients hospitalized from January 2015 to December 2018 in Shiyan area were enrolled.The general data of patients were carefully consulted,the situations of diagnosis and treatment were analyzed.Results 70 patients with DPLD were diagnosed by clinical-imaging-pathology.Non-specific interstitial pneumonia was the main pathological type.The clinical manifestations of patients with DPLD included cough,difficult breathing after exercise,shortness of breath,fever,etc.,the main signs were cyanosis,Velcro rale,moist rale,etc.;Chest X-ray examination was more common with reticular shadow,patchy shadow,nodular shadow,and they diffusely distributed,involving both lung fields;Chest CT examination revealed that the lesions involved bilateral lung fields,mainly bilateral middle and lower lungs,with patchy shadow,grid-like shadow and pleural thickening;Blood routine examination showed elevated erythrocyte sedimentation rate,elevated neutrophil count and elevated C-reactive protein;48 cases of the 70 patients underwent pulmonary function examination,,and restrictive ventilatory dysfunction was detected in 83.33%(40/48)of patients.Before pathological examination,23 patients received anti-infective treatment and 14 patients received glucocorticoid therapy.After pathological diagnosis,60 patients received anti-infective treatment,40 patients used hormones,34 patients took anti-infective combined with hormone therapy,and 7 patients received anti-infective,hormone combined with immunosuppressive agents.Among the 70 patients who did not give up treatment,1 cases died within 1 month of treatment.Conclusion DPLD occurs in the middle-aged and elderly population.The main symptoms are cough and dyspnea with progressive aggravation.The lung Velcro rale possibly indicates the connective tissue disease(CTD)-related lung disease and idiopathic pulmonary fibrosis(IPF).and is mainly caused by infectious diseases and CTD-related lung diseases.The glucocorticoids or(and)immunosuppressive agent are the main treatment methods,and the patients generally have a good prognosis and low mortality rate.