干扰素治疗乙型肝炎引起急性问质性肺炎1例及文献复习

目的 分析干扰素所致间质性肺炎的临床、影像学和病理学特征及治疗.方法 通过对1例干扰素α-2b治疗乙型肝炎导致间质性肺炎患者的临床、影像学及病理学及治疗转归分析,分别复习干扰素α治疗乙型肝炎和丙型肝炎导致间质性肺炎的相关文献,总结其特征.结果 患者因慢性乙型肝炎单用重组人干扰素α-2b治疗5个月后出现咳嗽、进行性呼吸困难 体检肺部少许细湿啰音 血气分析示Ⅰ型呼吸衰竭.胸部CT示双肺多发磨玻璃影、网格状影.经纤维支气管镜肺活检组织病理显示急性肺泡损伤、间质纤维化.糖皮质激素治疗后,症状逐渐好转,随诊5个月病情相对稳定.检索国内外文献,未见有干扰素α治疗乙肝引起间质性肺炎的报道.把关键词乙型肝炎更换为丙型肝炎,则共检索到27例报道.主要症状是咳嗽（70.4%）、呼吸困难（77.8%）和发热（29.6%）.出现症状的时间自用药后20 d至23周不等.除少数停药观察外,多数需要糖皮质激素治疗,死亡率为11.1%.结论 干扰素治疗乙型肝炎时可能诱发急性间质性肺炎,临床医师应提高警惕.

Acute interstitial pneumonia caused by interferon therapy for hepatitis B-one case report and review of literature

Objective To analyze the clinical, radiological and pathological features and treatment of interstitial pneumonia induced by interferon. Methods The clinical, radiological and pathological features and treatment of a patient with interstitial pneumonia induced by interferon α-2b therapy for hepatitis B were analyzed, the related literatures of interstitial pneumonia caused by interferon α-2b therapy for hepatitis B and hepatitis C were reviewed, and the characteristics was summarized. Results A chronic hepatitis B patients had cough and progressive dyspnea after treatment with recombinant human interferon α-2b for five months. Physical examination showed a little moist rales in the lung. Blood gas analysis showed type I respiratory failure. Chest computerized tomography showed multiple lung ground glass, grid-like shadow. Lung biopsy pathology by bronchofibroscope showed acute alveolar damage, interstitial fibrosis. The symptoms of patient gradually improved after glucocorticoid treatment. Followed up for five months, the patient＇s condition was relative stable. There was no report about interstitial pneumonia caused by interferon a therapy for hepatitis B. Replacing the key word hepatitis B into hepatitis C, 27 cases reported were retrieved. The main symptoms were cough （70. 4%）,dyspnea （77. 8%） and fever （29. 6%）. Onset of symptoms of interstitial pneumonia ranged from 20 days to 23 weeks of therapy. Apart from a few withdrawal observation, most needed glucocorticoid treatment, and the mortality rate was 11. 1 %. Conclusions Acute interstitial pneumonia may be induced by interferon therapy for hepatitis B, and clinicians should have vigilance on it.