Kohno S, Yamaguchi K, Yasuoka A, Koga H, Hayashi T, Komori K, Hara K
Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Jpn J Med. 1990 May-Jun;29(3):248-54. doi: 10.2169/internalmedicine1962.29.248.
The diagnosis of drug-induced pneumonitis is generally difficult, and it is made clinically by Tamura's criteria. We experienced 12 cases (7 definite and 5 possible cases) of antimicrobial drug-induced pneumonitis (one of case was the first case caused by carbapenem). Symptoms such as fever (11/12), cough (10/12) and dyspnea (10/12) and laboratory data such as eosinophilia (7/12), elevation of IgE (4/6) and hypoxia (11/12) were commonly seen in these patients, although they were not specific. Lymphocyte stimulation test (5/11) and provocation test (4/8) were quite suggestive of drug allergy. Bronchoscopy has been used for confirmation of pneumonitis. Transbronchial lung biopsy revealed alveolitis (4/9) or alveolar fibrosis (3/9), and bronchoalveolar lavage showed lymphocytosis (6/6) and depression of OKT4/T8 ratio (3/5). The combination of bronchoscopic and immunological examinations were more confirmative for diagnosis.
药物性肺炎的诊断通常较为困难，临床上依据田村标准进行诊断。我们诊治了12例抗菌药物所致肺炎（7例确诊，5例疑似）（其中1例为由碳青霉烯类药物引起的首例病例）。这些患者常见发热（11/12）、咳嗽（10/12）和呼吸困难（10/12）等症状，以及嗜酸性粒细胞增多（7/12）、IgE升高（4/6）和低氧血症（11/12）等实验室检查结果，尽管这些表现并不具有特异性。淋巴细胞刺激试验（5/11）和激发试验（4/8）对药物过敏有较强提示作用。支气管镜检查用于确诊肺炎。经支气管肺活检显示肺泡炎（4/9）或肺泡纤维化（3/9），支气管肺泡灌洗显示淋巴细胞增多（6/6）以及OKT4/T8比值降低（3/5）。支气管镜检查与免疫学检查相结合对诊断更具确诊价值。
