Wang Ping, Xu Zuo-jun, Xu Wen-bing, Shi Ju-hong, Tian Xin-lun, Feng Rui-e, Zhu Yuan-jue
Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2009 Dec;24(4):202-7. doi: 10.1016/s1001-9294(10)60002-8.
To assess the spectrum of causes, clinical features, differences between disease phases, and prognosis of extrinsic allergic alveolitis (EAA).
Patients with EAA diagnosed at Peking Union Medical College Hospital from August 1983 to May 2007 were analyzed retrospectively. Their medical records were examined to gather clinical, laboratorial, radiological, and histopathological data. Patients were divided to three phases (acute, subacute, and chronic) according to clinical presentations. Follow-up data regarding treatment response, subsequent radiological and pulmonary function studies, and clinical outcomes were collected.
A total of 21 cases were enrolled. Among them, 11 were subacute, 10 were chronic. The most common exposure was pet birds (6 cases, 28.6%). The primary abnormality of pulmonary function was restriction and/or reduction in diffusing capacity (12 cases, 63.2%). The most common findings on high-resolution computed tomography (HRCT) were ground-glass opacities (13 cases, 68.4%) and centrilobular nodules (8 cases, 42.1%). Airway obstruction in pulmonary function test, emphysema, lung cysts, and fibrosis on HRCT were more frequently seen in chronic than in subacute patients, though the differences were not statistically significant. Bronchoalveolar lavage fluid (BALF) showed lymphocytosis. The total cell count and the percentage of neutrophils were significantly higher in subacute than in chronic patients (P<0.05). Nonnecrotizing granulomas were seen in 8 (47.1%) cases. Improvement or normalization in symptoms, radiography, and pulmonary function test after treatment were seen in all 18 patients with available follow-up data. Five patients recurred.
The characteristic abnormalities of pulmonary function, findings on HRCT, and pathology are essential for all phases of EAA, and the atypical manifestations such as obstruction and fibrosis can also be present frequently, particularly in chronic cases. Differential cell counts of BALF are related to the phase of the disease. The treatment response and prognosis of EAA are good.
评估外源性过敏性肺泡炎（EAA）的病因谱、临床特征、疾病阶段差异及预后。
回顾性分析1983年8月至2007年5月在北京协和医院诊断为EAA的患者。查阅其病历以收集临床、实验室、放射学及组织病理学数据。根据临床表现将患者分为三个阶段（急性、亚急性和慢性）。收集关于治疗反应、后续放射学和肺功能研究以及临床结局的随访数据。
共纳入21例患者。其中，11例为亚急性，10例为慢性。最常见的暴露因素是宠物鸟（6例，28.6%）。肺功能的主要异常是限制性通气功能障碍和/或弥散功能降低（12例，63.2%）。高分辨率计算机断层扫描（HRCT）最常见的表现是磨玻璃影（13例，68.4%）和小叶中心结节（8例，42.1%）。虽然差异无统计学意义，但肺功能试验中的气道阻塞、肺气肿、肺囊肿以及HRCT上的纤维化在慢性患者中比在亚急性患者中更常见。支气管肺泡灌洗（BALF）显示淋巴细胞增多。亚急性患者的总细胞计数和中性粒细胞百分比显著高于慢性患者（P<0.05）。8例（47.1%）可见非坏死性肉芽肿。在有可用随访数据的18例患者中，治疗后症状、影像学和肺功能试验均有改善或恢复正常。5例患者复发。
EAA各阶段肺功能的特征性异常、HRCT表现及病理学特征至关重要，阻塞和纤维化等非典型表现也可能频繁出现，尤其是在慢性病例中。BALF细胞分类计数与疾病阶段相关。EAA的治疗反应和预后良好。
