Chabot F, Aymard B, Lesur O, Kheir A, Moreau L, Cornette A, Gerard H, Delorme N, Polu J M
Service des Maladies Respiratoires et Réanimation Respiratoire, Brabois, Vandoeuvre-lès-Nancy.
Rev Mal Respir. 1992;9(6):593-601.
The authors report ten cases of drug induced lung diseases, complicated by respiratory failure of whom five were attributed to cytotoxic drugs and five to non cytotoxic drugs. The drug induced lung disease presented as acute respiratory distress syndrome in two cases, alveolar interstitial lung disease in three cases, purely interstitial in five cases. There was acute respiratory failure (ARF) in eight cases and chronic respiratory failure (CRF) in two cases. Among the five patients admitted for cytotoxic drug induced lung disease and ARF, four recovered and one died of diffuse destructive pulmonary fibrosis. Among the five patients having non cytotoxic drug induced lung disease, three were in ARF and recovered. The other two had CRF and died of diffuse pulmonary fibrosis. The diagnostic of drug induced lung disease was established in each case with the chronology of the clinical events, the exclusion of other possible causes of the lung disease and the evolution after removal of the incriminated drug. Broncho-alveolar lavage (BAL) had a major diagnostic value. It was contraindicated by respiratory failure in five cases. The predominant alveolar cell type was lymphocyte (four cases), eosinophil (three cases) and neutrophil (one case), BAL was realized with a provocation test and demonstrated the pathogenic role of cyclothiazide in one case. No specific information was given by histology. The prognosis did not seem to be linked to the severity of the initial clinical picture, or to the nature of the underlying neoplastic disorder, but to the degree and evolution of the pulmonary fibrosis.
作者报告了10例药物性肺疾病合并呼吸衰竭的病例，其中5例归因于细胞毒性药物，5例归因于非细胞毒性药物。药物性肺疾病表现为急性呼吸窘迫综合征2例，肺泡间质性肺疾病3例，单纯间质性5例。8例出现急性呼吸衰竭（ARF），2例出现慢性呼吸衰竭（CRF）。在因细胞毒性药物引起的肺疾病和ARF而入院的5例患者中，4例康复，1例死于弥漫性破坏性肺纤维化。在5例非细胞毒性药物引起的肺疾病患者中，3例发生ARF并康复。另外2例患有CRF，死于弥漫性肺纤维化。根据临床事件的时间顺序、排除其他可能的肺部疾病原因以及停用相关药物后的病情演变，对每例药物性肺疾病进行了诊断。支气管肺泡灌洗（BAL）具有重要的诊断价值。5例因呼吸衰竭而禁忌进行此项检查。肺泡主要细胞类型为淋巴细胞（4例）、嗜酸性粒细胞（3例）和中性粒细胞（1例），1例通过激发试验进行BAL检查，证实了环噻嗪的致病作用。组织学检查未提供具体信息。预后似乎与初始临床表现的严重程度或潜在肿瘤性疾病的性质无关，而是与肺纤维化的程度和演变有关。
