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[25例嗜酸性粒细胞性肺病的临床分析]

[A clinical analysis of twenty-five cases of eosinophilic lung disease].

作者信息

Liang Qiong, Chen Yiqiang, Kong Jinliang, Pan Yiping

机构信息

Department of Respiratory Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.

Department of Respiratory Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Email:

出版信息

Zhonghua Nei Ke Za Zhi. 2015 May;54(5):426-30.

Abstract

OBJECTIVE

To improve the diagnosis and treatment of eosinophilic lung disease.

METHODS

Patients who were diagnosed with eosinophilic lung disease and hospitalized in the First Affiliated Hospital of Guangxi Medical University Hospital were retrospectively analyzed from January 2004 to August 2012. Data of etiology, clinical manifestation, imaging and pathological features, diagnosis and treatment were recorded.

RESULTS

A total of 25 patients were diagnosed with eosinophilic lung disease including 9 chronic eosinophilic pneumonia, 6 churg-strauss syndrome, and 10 cases of parasitic infection of which two patients were the simple pulmonary eosinophilia (Löffler syndrome). Eosinophil counts in peripheral blood and bronchoalveolar lavage fluid (BALF) were increased. Arterial gas analysis showed varying degree of hypoxemia, which pulmonary function tests showed restrictive, obstructive, mixed ventilatory dysfunction. Chest CT showed bilateral flaky, streak or flake diffuse ground-glass infiltrates and reticular opacities. Results of pulmonary biopsy or skin biopsy identified diffuse eosinophil infiltration. Corticoidsteroid therapy alone or combined with immunosuppressive agents were both effective.

CONCLUSION

(1) Liver fluke and other food-borne parasites are the most common causes in eosinophilic lung disease; followed by unexplained chronic acidophilic granulocyte pneumonia; (2) In addition to histopathological evidence, the diagnosis of eosinophilic lung disease was made comprehensively based on clinical features, laboratory test, the BALF analysis, and imaging data.

摘要

目的

提高嗜酸性粒细胞性肺病的诊断与治疗水平。

方法

回顾性分析2004年1月至2012年8月在广西医科大学第一附属医院住院治疗的嗜酸性粒细胞性肺病患者。记录病因、临床表现、影像学及病理特征、诊断与治疗等资料。

结果

共诊断出25例嗜酸性粒细胞性肺病患者,其中慢性嗜酸性粒细胞性肺炎9例,变应性肉芽肿性血管炎6例,寄生虫感染10例,其中2例为单纯性肺嗜酸性粒细胞增多症(吕弗勒综合征)。外周血及支气管肺泡灌洗液(BALF)中的嗜酸性粒细胞计数升高。动脉血气分析显示不同程度的低氧血症,肺功能检查显示限制性、阻塞性、混合性通气功能障碍。胸部CT表现为双侧片状、条索状或斑片状弥漫性磨玻璃影及网状阴影。肺活检或皮肤活检结果显示有弥漫性嗜酸性粒细胞浸润。单独使用糖皮质激素或联合免疫抑制剂治疗均有效。

结论

(1)肝吸虫及其他食源性寄生虫是嗜酸性粒细胞性肺病最常见的病因;其次是不明原因的慢性嗜酸性粒细胞性肺炎;(2)嗜酸性粒细胞性肺病的诊断除组织病理学证据外,还需综合临床特征、实验室检查、BALF分析及影像学资料进行判断。

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