Guillon J M, Joly P, Autran B, Denis M, Akoun G, Debré P, Mayaud C
Hôpital Tenon, Paris, France.
Ann Intern Med. 1992 Sep 15;117(6):476-81. doi: 10.7326/0003-4819-117-6-476.
To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis.
Case study.
Intensive care unit of a referral hospital.
A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amoxicillin, and erythromycin.
Sequential bronchoalveolar lavages after reexposure to minocycline and amoxicillin.
Immunologic analysis of the phenotype and function of alveolar lymphocytes.
Reexposure to minocycline but not to amoxicillin was followed by an interstitial pneumonitis. Sequential bronchoalveolar lavages showed a transient rise of eosinophils and neutrophils and a persistent alveolar lymphocytosis. Alveolar lymphocytes consisted predominantly of CD8+ but also CD4+ cells. Two CD8+ lymphocyte subsets were identified: CD8+ D44+ cytotoxic T cells that increased rapidly after the drug was resumed and CD8+ CD57+ suppressor T cells that predominated 11 days after the drug's withdrawal. In-vitro assays showed the presence of a lymphocyte-mediated specific cytotoxicity against minocycline-bearing alveolar macrophages.
These results support the hypothesis of a central role of T lymphocytes in the pathogenesis of drug-related hypersensitivity pneumonitis.
确定过敏性肺炎的病因并明确其发病机制。
病例研究。
一家转诊医院的重症监护病房。
一名51岁的慢性支气管炎男性患者，在接触米诺环素、阿莫西林和红霉素后1个月内发生了过敏性肺炎。
再次接触米诺环素和阿莫西林后进行序贯支气管肺泡灌洗。
对肺泡淋巴细胞的表型和功能进行免疫学分析。
再次接触米诺环素而非阿莫西林后出现间质性肺炎。序贯支气管肺泡灌洗显示嗜酸性粒细胞和中性粒细胞短暂升高，肺泡淋巴细胞持续增多。肺泡淋巴细胞主要由CD8⁺细胞组成，但也有CD4⁺细胞。鉴定出两个CD8⁺淋巴细胞亚群：重新用药后迅速增加的CD8⁺ D44⁺细胞毒性T细胞和停药11天后占主导的CD8⁺ CD57⁺抑制性T细胞。体外试验显示存在针对携带米诺环素的肺泡巨噬细胞的淋巴细胞介导的特异性细胞毒性。
这些结果支持T淋巴细胞在药物相关性过敏性肺炎发病机制中起核心作用的假说。
