Division of Pulmonary and Critical Care Medicine, Meharry Medical College, Nashville, TN, USA.
N Engl J Med. 2011 Jul 21;365(3):222-30. doi: 10.1056/NEJMoa1101388.
In this descriptive case series, 80 soldiers from Fort Campbell, Kentucky, with inhalational exposures during service in Iraq and Afghanistan were evaluated for dyspnea on exertion that prevented them from meeting the U.S. Army's standards for physical fitness.
The soldiers underwent extensive evaluation of their medical and exposure history, physical examination, pulmonary-function testing, and high-resolution computed tomography (CT). A total of 49 soldiers underwent thoracoscopic lung biopsy after noninvasive evaluation did not provide an explanation for their symptoms. Data on cardiopulmonary-exercise and pulmonary-function testing were compared with data obtained from historical military control subjects.
Among the soldiers who were referred for evaluation, a history of inhalational exposure to a 2003 sulfur-mine fire in Iraq was common but not universal. Of the 49 soldiers who underwent lung biopsy, all biopsy samples were abnormal, with 38 soldiers having changes that were diagnostic of constrictive bronchiolitis. In the remaining 11 soldiers, diagnoses other than constrictive bronchiolitis that could explain the presenting dyspnea were established. All soldiers with constrictive bronchiolitis had normal results on chest radiography, but about one quarter were found to have mosaic air trapping or centrilobular nodules on chest CT. The results of pulmonary-function and cardiopulmonary-exercise testing were generally within normal population limits but were inferior to those of the military control subjects.
In 49 previously healthy soldiers with unexplained exertional dyspnea and diminished exercise tolerance after deployment, an analysis of biopsy samples showed diffuse constrictive bronchiolitis, which was possibly associated with inhalational exposure, in 38 soldiers.
在这项描述性病例系列研究中，对来自肯塔基州坎贝尔堡的 80 名士兵进行了评估，这些士兵在伊拉克和阿富汗服役期间吸入了有害物质，出现了运动时呼吸困难的症状，且无法达到美国陆军的体能标准。
对士兵的医疗和暴露史、体格检查、肺功能检查和高分辨率计算机断层扫描（CT）进行了广泛评估。对无法通过非侵入性评估解释症状的 49 名士兵进行了胸腔镜肺活检。将心肺运动和肺功能测试的数据与从历史军事对照组获得的数据进行了比较。
在接受评估的士兵中，有吸入 2003 年伊拉克硫磺矿火灾物质的历史较为常见，但并非普遍现象。在接受肺活检的 49 名士兵中，所有活检样本均异常，其中 38 名士兵的改变符合缩窄性细支气管炎的诊断。在其余 11 名士兵中，确定了除缩窄性细支气管炎以外可以解释其出现的呼吸困难的其他诊断。所有患有缩窄性细支气管炎的士兵的胸部 X 线检查结果均正常，但约四分之一的患者在胸部 CT 上显示有马赛克样空气潴留或小叶中心结节。肺功能和心肺运动测试的结果通常在正常人群范围内，但低于军事对照组。
在 49 名先前健康的士兵中，他们在部署后出现不明原因的运动性呼吸困难和运动耐量下降，对活检样本的分析显示，38 名士兵存在弥漫性缩窄性细支气管炎，可能与吸入暴露有关。
