Aoshiba K, Fukuda I, Mochizuki M, Tamaoki J, Konno K, Takizawa T
Department of Medicine 1, Tokyo Women's Medical College.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Feb;28(2):336-43.
A 26-year-old female with gold lung induced by Shiosol (gold thiomalate) administered for her rheumatoid arthritis is presented. Chest X-ray films after treatment with prednisolone hardly improved and showed diffuse fibrotic shadow. We reviewed previously reported cases of gold lung and tried to determine the clinical factors which might affect the development of pulmonary fibrotic changes in gold lung. The cases reported in Japan were classified into two groups according to the improvement of X-ray films after steroid therapy: group A in which the chest X-ray film returned to almost normal, group B these with diffuse fibrotic shadow. No significant difference was observed in the values of %VC and PaO2 admission between the two groups. The total dose of gold received was greater (p less than 0.05) and the duration of gold received was longer (p less than 0.01) in group B than in group A. These findings suggest that the development of pulmonary fibrosis does not depend on the severity of the injury indicated by pulmonary function, but in part on the amount of gold which has been stored in pulmonary macrophages. No statistical difference was shown in the initial dose of steroids between these groups. The duration between the onset of gold lung and the start of steroid therapy were longer in group B than than group A (p less than 0.05). Thus, early diagnosis and treatment with steroids are highly recommended in the clinical management of patients with gold lung.
本文报告了一名26岁女性，因类风湿关节炎接受硫代苹果酸金钠（Shiosol）治疗后诱发金肺。使用泼尼松龙治疗后的胸部X光片几乎没有改善，显示出弥漫性纤维化阴影。我们回顾了先前报道的金肺病例，并试图确定可能影响金肺肺纤维化变化发展的临床因素。日本报道的病例根据类固醇治疗后X光片的改善情况分为两组：A组胸部X光片恢复至几乎正常，B组有弥漫性纤维化阴影。两组间入院时的%VC和PaO2值无显著差异。B组接受的金总量更大（p<0.05），接受金的持续时间更长（p<0.01）。这些发现表明，肺纤维化的发展并不取决于肺功能所指示的损伤严重程度，部分取决于肺巨噬细胞中储存的金量。两组间初始类固醇剂量无统计学差异。B组金肺发病与开始类固醇治疗之间的时间比A组更长（p<0.05）。因此，在金肺患者的临床管理中，强烈建议早期诊断并使用类固醇进行治疗。
