Costabel U
Abteilung Pneumologie/Allergologie, Ruhrlandklinik, Essen.
Z Rheumatol. 1990 Sep-Oct;49(5):284-90.
In rheumatologic disorders cytostatics and immunosuppressive agents are frequently applied and may lead to damage of the lung parenchyma. In the pathogenesis, toxic and immunologic mechanisms are discussed. In the differential diagnosis, pulmonary manifestations of the underlying disorder and infections are important. The diagnosis is confirmed by historical, clinical, histological, and cytologic findings (bronchoalveolar lavage). This review focuses on aspirin, gold, D-penicillamine, methotrexate, cyclophosphamide, and azathioprine treatments. Pulmonary side effects are rare, but early diagnosis is important, because withdrawal of the drug may lead to full recovery of the patient. The prognosis is poor in D-penicillamine or cyclophosphamide induced pneumonitis with a lethal course in 40-50%. The interval between start of treatment and manifestation of lung damage can range from a few weeks to several years. Beside pulmonary symptoms such as cough and dyspnea, fever may occur. Pulmonary function tests show restriction and impairment of diffusion. Gold and methotrexate can induce blood eosinophilia. In bronchoalveolar lavage, the most frequent finding is an increase in lymphocytes with a decrease of the CD4/CD8 ratio. Some drugs, however, can also lead to an increase of the neutrophils and/or the eosinophils in the lavage fluid. Bronchoalveolar lavage can contribute to the exclusion of infections or pulmonary manifestations of the underlying disorder.
在风湿性疾病中，细胞毒性药物和免疫抑制剂经常被使用，可能导致肺实质损伤。在发病机制方面，涉及毒性和免疫机制的讨论。在鉴别诊断中，基础疾病的肺部表现和感染很重要。诊断通过病史、临床、组织学和细胞学检查结果（支气管肺泡灌洗）得以证实。本综述重点关注阿司匹林、金制剂、D-青霉胺、甲氨蝶呤、环磷酰胺和硫唑嘌呤的治疗。肺部副作用罕见，但早期诊断很重要，因为停药可能使患者完全康复。D-青霉胺或环磷酰胺所致肺炎的预后较差，40% - 50%会有致命病程。治疗开始至肺损伤表现出现的间隔时间可从数周至数年不等。除咳嗽和呼吸困难等肺部症状外，还可能出现发热。肺功能检查显示有通气受限和弥散功能损害。金制剂和甲氨蝶呤可导致血液嗜酸性粒细胞增多。在支气管肺泡灌洗中，最常见的发现是淋巴细胞增多，CD4/CD8比值降低。然而，某些药物也可导致灌洗液中中性粒细胞和/或嗜酸性粒细胞增多。支气管肺泡灌洗有助于排除感染或基础疾病的肺部表现。
