Wang Y, Tong Y Q, Zhou W, Tian Z L, Li N N, Lyu X X, Sun T Y, Ke H X
Department of Respiratory and Critical Care Medicine,Beijing Hospital National Center of Gerontology,Institute of Geriatric Medcine, Chinese Academy of Medical Science, Beijing 100730,China.
Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2021 May 12;44(5):481-487. doi: 10.3760/cma.j.cn112147-20200818-00906.
To improve the clinical recognition of electronic cigarette or vaping product use-associated lung injury. A 67 year old patient with lung injury induced by e-cigarette was reported. The concentrations of vitamin E acetate (VEA) and tetrahydrocannabinol (Δ9-THC) in BALF were measured by UHPLC-MS/MS. A literature review was performed with"Vaping-Associated Lung Injury""vape","e-cigarette","electronic cigarette","EVALI","electronic nicotine device","lung","injury","case"as Mesh terms in PubMed. There were 208 cases reported in the literature, 71.6% of whom were male, and 28.4% were female, with a median age of 27 years (17-67 years), while 2 patients (1%) were over 60 years old. The median time of using e-cigarette was 90 days (2 weeks-3 years). Of the 208 patients, the most common symptoms were dyspnea, fever, chest pain, hemoptysis, and gastrointestinal symptoms such as nausea, abdominal pain or diarrhea. The most common manifestation of chest CT was bilateral ground glass opacity (=119, 57.2%). A total of 70 patients received bronchoscopy and BALF, which showed that the ratio of macrophages was (49.5±29.8)%, neutrophil (34.7±28.7)%, lymphocytes (10.1±7.4)%, and eosinophils (2.4±3.6)%. The "foamy" alveolar macrophages were positive in 65 cases (92.9%).A total of 132 patients (63.5%) were treated with antibiotics, and 162 patients (77.9%) were treated with glucocorticoids. The initial dose of methylprednisolone was 40 mg and the maximum was 500 mg. 48 patients (23.1%) were mechanically ventilated and 10 patients (4.8%) were treated with extracorporeal membrane oxygenation (ECMO). Of the 208 patients, 202(97.1%) patients improved and 6 (2.9%) died. Our case and reported cases should alert physicians to the clinical presentation of vaping-associated lung injury for early diagnosis and prompt management. It is suggested that the standardized management of e-cigarette should be strengthened to avoid similar situation of e-cigarette-related lung injury in China. Additional work is needed to characterize the pathophysiology of this disease.
为提高对电子烟或雾化产品使用相关肺损伤的临床认识。报告了1例67岁因电子烟导致肺损伤的患者。采用超高效液相色谱-串联质谱法（UHPLC-MS/MS）测定支气管肺泡灌洗液（BALF）中维生素E醋酸酯（VEA）和四氢大麻酚（Δ9-THC）的浓度。在PubMed数据库中以“雾化相关肺损伤”“雾化”“电子烟”“电子香烟”“电子烟或雾化产品使用相关肺损伤（EVALI）”“电子尼古丁装置”“肺”“损伤”“病例”作为医学主题词进行文献综述。文献中共报道208例病例，其中男性占71.6%，女性占28.4%，中位年龄为27岁（17 - 67岁），60岁以上患者2例（1%）。使用电子烟的中位时间为90天（2周 - 3年）。208例患者中，最常见的症状为呼吸困难、发热、胸痛、咯血以及恶心、腹痛或腹泻等胃肠道症状。胸部CT最常见的表现为双侧磨玻璃影（n = 119，57.2%）。共有70例患者接受支气管镜检查及BALF检查，结果显示巨噬细胞比例为（49.5±29.8）%，中性粒细胞（34.7±28.7）%，淋巴细胞（10.1±7.4）%，嗜酸性粒细胞（2.4±3.6）%。65例（92.9%）“泡沫状”肺泡巨噬细胞呈阳性。共有132例患者（63.5%）接受抗生素治疗，162例患者（77.9%）接受糖皮质激素治疗。甲泼尼龙初始剂量为40mg，最大剂量为500mg。48例患者（23.1%）接受机械通气，10例患者（4.8%）接受体外膜肺氧合（ECMO）治疗。208例患者中，202例（97.1%）病情好转，6例（2.9%）死亡。我们的病例及已报道病例应提醒医生注意雾化相关肺损伤的临床表现，以便早期诊断和及时处理。建议加强对电子烟的规范管理，避免我国出现类似电子烟相关肺损伤的情况。还需要进一步开展工作以明确该疾病的病理生理学特征。
