论著
ENGLISH ABSTRACT
慢性嗜酸粒细胞性肺炎9例临床分析
曾荣
梁子婷
黄思源
张锦涛
乔馨蕊
杨慧
董亮
作者及单位信息
·
DOI: 10.3760/cma.j.cn112147-20211213-00881
Clinical analysis of chronic eosinophilic pneumonia in 9 cases
Zeng Rong
Liang Ziting
Huang Siyuan
Zhang Jintao
Qiao Xinrui
Yang Hui
Dong Liang
Authors Info & Affiliations
Zeng Rong
Department of Respiratory and Critical Care Medicine, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Shandong Institute of Respiratory Diseases, Jinan 250014, China
Liang Ziting
Department of Respiratory and Critical Care Medicine, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Shandong Institute of Respiratory Diseases, Jinan 250014, China
Huang Siyuan
Department of Respiratory and Critical Care Medicine, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Shandong Institute of Respiratory Diseases, Jinan 250014, China
Zhang Jintao
Department of Respiratory and Critical Care Medicine, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Shandong Institute of Respiratory Diseases, Jinan 250014, China
Qiao Xinrui
Department of Respiratory and Critical Care Medicine, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Shandong Institute of Respiratory Diseases, Jinan 250014, China
Yang Hui
Department of Respiratory and Critical Care Medicine, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Shandong Institute of Respiratory Diseases, Jinan 250014, China
Dong Liang
Department of Respiratory and Critical Care Medicine, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Shandong Institute of Respiratory Diseases, Jinan 250014, China
·
DOI: 10.3760/cma.j.cn112147-20211213-00881
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摘要

目的分析慢性嗜酸粒细胞性肺炎(CEP)的临床特征、治疗转归等要点,提高临床诊治能力。

方法回顾性收集山东省千佛山医院2014年1月至2020年12月诊断为CEP的9例患者的临床资料,并进行随访。

结果9例患者中男1例,女8例,年龄16~71岁,中位年龄47岁。5例合并支气管哮喘,1例合并过敏性鼻炎,1例有花粉过敏史。主要临床表现为咳嗽(9/9)、咳痰(9/9),胸闷(9/9)、憋喘(9/9),少数伴乏力(3/9)、发热(1/9)、胸痛(1/9)。影像学上可见单发或多发的斑片状高密度影(9/9),纵隔淋巴结肿大(7/9),支气管充气征(2/9)和网格状改变(1/9)等。9例患者外周血嗜酸粒细胞(EOS)、血清总IgE均不同程度升高。5例行支气管镜检查的患者肺泡灌洗液中EOS百分比均升高,其余4例经皮肺活检的患者组织病理均提示肺泡腔或间质中EOS浸润。经糖皮质激素治疗0.5~1个月后复查,9例患者的临床症状明显缓解,肺部病灶均见吸收,随访中4例复发。

结论对于有过敏史,血EOS计数、总IgE升高并伴肺部多发高密度影或实变的患者,尤其是女性患者,临床医生应警惕其可能为CEP。支气管镜和经皮肺穿刺活检有助于明确诊断。糖皮质激素治疗效果佳,但复发率高。

肺嗜酸粒细胞增多;临床特征;诊断;治疗
ABSTRACT

ObjectiveTo investigate the clinical features, treatment and prognosis of chronic eosinophilic pneumonia.

MethodsNine patients with chronic eosinophilic pneumonia diagnosed in Shandong Provincial Qianfoshan Hospital from January 2014 to December 2020 were enrolled and followed up. The data of clinically proven chronic eosinophilic pneumonia were reviewed.

ResultsThe 9 cases included one male and eight females, aged from 16 to 71 years (median 47 years). Among them, 5 cases were complicated with asthma, 1 case was complicated with allergic rhinitis, and 1 case had an allergic history of pollen. All the patients had cough, expectoration, chest tightness and wheezing, and a few had fatigue (3/9), fever (1/9) and chest pain (1/9). Single or multiple patchy high-density shadows (9/9), mediastinal lymphadenopathy (7/9), air bronchogram (2/9), and reticular shadow (1/9) were observed in chest CT. Peripheral eosinophils (EOS) and serum total IgE increased to varying degrees in the 9 patients. Meanwhile, the bronchoscopy of 5 cases showed elevated percentage of eosinophils in alveolar lavage fluid, and the lung biopsy of remaining 4 cases showed EOS infiltration in lung alveolar and interstitium. After receiving glucocorticoid therapy for 0.5 to 1 month, the clinical symptoms of all 9 patients had been improved and lung lesions on CT scans had been obviously absorbed. Four cases relapsed during follow-up.

ConclusionsFor patients especially women who have a history of allergy, elevated blood eosinophils and serum total IgE with pulmonary high-density shadow or consolidation, chronic eosinophilic pneumonia should be considered, and bronchoscopy or percutaneous lung biopsy is indicated for a definite diagnosis. Glucocorticoid therapy is effective, but the rate of recurrence is high.

Pulmonary eosinophilia;Clinical features;Diagnosis;Treatment
Dong Liang, Email: mocdef.6ab216055ld
引用本文

曾荣,梁子婷,黄思源,等. 慢性嗜酸粒细胞性肺炎9例临床分析[J]. 中华结核和呼吸杂志,2022,45(04):368-372.

DOI:10.3760/cma.j.cn112147-20211213-00881

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*以上评分为匿名评价
慢性嗜酸粒细胞性肺炎(chronic eosinophilic pneumonia,CEP)在1969年由Carrington等 1首次提出,并被认为是一种特发性间质性肺疾病。主要表现为进行性呼吸困难、咳嗽,外周血嗜酸粒细胞(eosinophil,EOS)增多和周围性肺浸润,组织病理学可见肺间质及肺泡中EOS明显集聚 2。该病在临床上较少见,早期识别及诊断困难,需排除其他嗜酸性疾病。现对9例CEP患者的临床资料进行分析,旨在提高临床医生对该病的认识水平及诊疗能力。
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备注信息
A
董亮,Email: mocdef.6ab216055ld
B

曾荣、梁子婷:研究设计,数据收集,论文撰写;黄思源、张锦涛:数据收集,论文修改;乔馨蕊、杨慧:数据收集;董亮:论文修改,经费支持

C

曾荣, 梁子婷, 黄思源, 等. 慢性嗜酸粒细胞性肺炎9例临床分析[J]. 中华结核和呼吸杂志, 2022, 45(4): 368-372. DOI: 10.3760/cma.j.cn112147-20211213-00881.

D
所有作者声明无利益冲突
E
国家自然科学基金 (81770029)
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