Adams Traci N, Butt Yasmeen M, Batra Kiran, Glazer Craig S
University of Texas Southwestern Medical Center, Department of Pulmonary and Critical Care Medicine, United States.
University of Texas Southwestern Medical Center, Department of Pathology, United States.
Respir Med. 2017 Aug;129:91-97. doi: 10.1016/j.rmed.2017.06.008. Epub 2017 Jun 13.
Cobalt exposure in the hard metal and bonded diamond tool industry is a well-established cause of ILD. The primary theories regarding the underlying mechanism of cobalt related ILD include an immunologic mechanism and an oxidant injury mechanism. Cobalt related ILD may present in subacute and chronic forms and often has associated upper respiratory symptoms. The evaluation begins with a thorough occupational history and includes PFTs, HRCT, and bronchoalveolar lavage. HRCT findings are nonspecific and may resemble NSIP, UIP, sarcoidosis, or HP. The finding of cannibalistic multinucleated giant cells is diagnostic provided there is a history of exposure and appropriate changes on imaging; however, when these cells are not found on lavage, lung biopsy is required for diagnosis. Giant cell interstitial pneumonia is the classic pathologic pattern, but cobalt related ILD may also present with pathologic findings of UIP, DIP, or HP. When cobalt related ILD is suspected, removal from exposure is the most important step in treatment. Case reports suggest that treatment with steroids results in symptomatic, physiologic, and radiographic improvement.
在硬质合金和金刚石工具行业中，接触钴是间质性肺病（ILD）的一个公认病因。关于钴相关ILD潜在机制的主要理论包括免疫机制和氧化损伤机制。钴相关ILD可能以亚急性和慢性形式出现，且常伴有上呼吸道症状。评估从详细的职业史开始，包括肺功能测试（PFTs）、高分辨率计算机断层扫描（HRCT）和支气管肺泡灌洗。HRCT表现无特异性，可能类似于非特异性间质性肺炎（NSIP）、寻常型间质性肺炎（UIP）、结节病或过敏性肺炎（HP）。如果有接触史且影像学有相应改变，发现噬食性多核巨细胞具有诊断意义；然而，当灌洗未发现这些细胞时，诊断需要进行肺活检。巨细胞间质性肺炎是典型的病理模式，但钴相关ILD也可能表现为UIP、脱屑性间质性肺炎（DIP）或HP的病理表现。当怀疑钴相关ILD时，脱离接触是治疗中最重要的步骤。病例报告表明，使用类固醇治疗可使症状、生理和影像学得到改善。
