特发性急性嗜酸粒细胞性肺炎1例报告

患者女性46岁,农民,因突然呼吸困难,剧裂右胸痛5天,于04年4月3日入院。该患者5天前无明显诱因出现呼吸困难,右胸痛,且伴咳嗽,咳少许白痰,发热,最高时体温可达38.2℃,曾静点青每素3天,症状无好转,既往健康。当时查肺CT示右下叶背段近胸膜处有片状高密度影,左上肺有片状高密度影,右侧少量胸腔积液。血气分析示PH,7.420,PCO235mmHg PO253Hg血常规WBC10.3×109/LGR75%。余正常。当时医院考虑肺栓塞可能性极大,给予溶栓治疗(具体溶栓方案不详),但病情不见好转,为求系统诊治而入我院。入院查:急性痛苦病容,Bp120/70mmHg,P86次/分,R25次/…     

老年急性嗜酸粒细胞性肺炎1例及文献复习

目的：探讨急性嗜酸粒细胞性肺炎(acute eosinophilic pneumonia,AEP)患者的临床特点、诊治和预后,提高临床诊治水平。方法分析北京医院收治的1例老年男性 AEP 患者的临床、影像学和病理学特点,并结合文献复习加以总结。结果患者以咳嗽、咳痰、发热起病。胸部 CT 示双肺多发斑片影伴少量胸腔积液,抗感染治疗无效。经皮肺穿刺活检病理提示 AEP,给予糖皮质激素治疗后好转。结论 AEP 是一种少见病,易被误诊为细菌性肺炎,对糖皮质激素敏感,早期明确诊断,规范治疗,治愈后无复发,预后良好。     

急性嗜酸粒细胞肺炎

急性嗜酸粒细胞肺炎是１９８９年Ａｌｌｅｎ等提出的一个新病种。本文就其可能的病因、临床特征、诊断和鉴别诊断等问题作一概述。     

慢性嗜酸粒细胞性肺炎10例临床分析

目的 总结慢性嗜酸粒细胞性肺炎(CEP)的临床特点,提高诊治水平.方法 回顾性分析1995年1月至2011年1月在北京协和医院住院的10例CEP患者的临床资料.结果 男性5例,女性5例,合并过敏性鼻炎3例,合并支气管哮喘2例,具有过敏史者2例.主要临床表现为发热(8/10)、咳嗽(8/10)、咯痰(7/10)、呼吸困难...     

糖皮质激素对嗜酸粒细胞的作用

嗜酸粒细胞（Ｅｏｓ）是糖皮质激素（ＧＣＳ）作用的重要靶细胞，ＧＣＳ通过干预细胞因子网络，间接抑制Ｅｏｓ的生成，存活和功能，ＧＣＳ对Ｅｏｓ凋亡可能具有直接作用，深入研究细胞信号转导，膜受体与ｍＲＮＡ转录之间的关系，将进一步阐明ＧＣＳ作用的分子机制。     

糖皮质激素对支气管哮喘患者痰嗜酸粒细胞和中性粒细胞凋亡的影响

为观察吸入糖皮质激素对支气管哮喘(简称哮喘)患者诱导痰中嗜酸粒细胞(EOS)和中性粒细胞凋亡的影响,我们对哮喘患者经糖皮质激素治疗前、后诱导痰中EOS和中性粒细胞凋亡进行对比研究。对象与方法　2 0例来自本院2 0 0 2年11月～2 0 0 3年3月门诊哮喘患者,男11例,女9例,平均年龄( 4 1±11)岁,符合1997年中华医学会呼吸病学分会哮喘学组的诊断标准[1] ,均为急性发作期(轻、中度) ,2 0例患者吸入糖皮质激素前为A组,给予吸入丙酸氟替卡松(商品名:辅舒酮,葛兰素史克公司) 2 5 0 μg ,每天2次,吸入4周后,视为B组,期间给以硫酸沙丁胺醇(商品名:…     

慢性嗜酸粒细胞性肺炎的诊断和治疗

对一例肺活检证实的慢性嗜酸粒细胞性肺炎（CEP）作了描述，并结合文献讨论，CEP病程呈亚急性或慢性，症状有发热、咳嗽、盗汗、体重减轻和困难；两肺有干湿罗音；胸部X线显示非游走性、非节段性的周围性肺浸润，周围血嗜酸粒细胞升高；皮质激素疗效明显，但须防复发，指出非周围性肺浸润病灶或嗜酸粒细胞不增高者应进行纤维支气管镜肺活检确诊。     

急性嗜酸粒细胞性肺炎2例并文献复习

目的:探讨急性嗜酸粒细胞性肺炎(AEP)的临床特点。方法:分析总结南京鼓楼医院集团宿迁医院确诊的2例急性嗜酸粒细胞性肺炎患者的临床诊治特点。分别以"急性嗜酸肺炎" "acute eosinophilic pneumonia"和"AEP"为检索词,检索2000-2021年的中国知网数据库及PubMed数据库并复习相关文献...     

急性嗜酸粒细胞性肺炎1例并文献复习

目的 探讨急性嗜酸性粒细胞肺炎的临床表现、诊断、治疗方法及预后.方法 结合我院收治的1例急性嗜酸粒细胞性肺炎的临床资料及国内外文献报道的病例进行综合分析.结果 患者18岁,青年男性,咳嗽、咯痰10余天,胸闷、胸痛8 d,加重伴发热4 d入院.胸部CT示双肺炎,双侧胸腔积液,抗感染治疗无效,病情进行性加重,胸水中找到嗜酸...     

嗜酸粒细胞凋亡与支气管哮喘

现已明确细胞凋亡是人体清除衰老和不需要的细胞的正常生理过程，一些学者认为嗜酸粒细胞调亡的异常可能是支气管哮喘病人气道嗜酸粒细胞持续存在、活化、细胞内生物活性物质释放的主要原因，因而是支气管哮喘的重要发病机制之一。本文就嗜酸粒细胞凋亡与支气管哮喘的关系方面的研究进展作一介绍。     

Fatal idiopathic acute eosinophilic pneumonia with acute lung injury

A fatal case of idiopathic eosinophilic pneumonia with acute lung injury is described. The patient required treatment with mechanical ventilation and intravenous corticosteroids, however, she died on the third hospital day. At autopsy, both exudative and proliferative phases of diffuse alveolar damage were observed bilaterally. Marked eosinophilic infiltrate was noted in the alveolar wall and within the alveolar cavities with occasional abscess-like features. To our knowledge, this is the first report of fatal acute eosinophilic pneumonia, and provides important information for the management of this condition.     

急性纤维蛋白性机化性肺炎的临床病理特征

目的介绍一种新近定义的弥漫性急性肺损伤类型-急性纤维蛋白性机化性肺炎,以提高临床医生对其的认识方法分析南京市鼓楼医院确诊的1例患者以及国外有关文献的报道,总结其临床特征。结果急性纤维蛋白性机化性肺炎患者表现为急性或亚急性起病,主要临床表现为呼吸困难、咳嗽、咳痰,肺功能为限制性通气功能障碍和弥散降低,CT可见两肺斑片状实变影,主要病理表现为肺泡腔内可以看到特征性纤维蛋白球以及机化的疏松结缔组织,而没有DAD中的经典透明膜形成。结论急性纤维蛋白性机化性肺炎的病理组织学特点决定了它是一种不同于弥漫性肺泡损伤、机化性肺炎和嗜酸细胞性肺炎的新的肺损伤类型,但其是否为一个独特的疾病综合征有待进一步明确。     

Viral infections in patients with an acute exacerbation of idiopathic interstitial pneumonia

BackgroundPatients with slowly progressive idiopathic interstitial pneumonia, including idiopathic pulmonary fibrosis, often deteriorate, thus suggesting that the clinical course may be unpredictable. Such episodes are termed acute exacerbation of idiopathic interstitial pneumonia. The etiology of an acute exacerbation of idiopathic interstitial pneumonia is unknown. In this study, we tested the hypothesis that an acute exacerbation of idiopathic interstitial pneumonia is induced by respiratory viral infections.MethodsBronchoalveolar lavage fluid obtained from patients with an acute exacerbation of idiopathic interstitial pneumonia was tested for viral nucleic acid using polymerase chain reaction.ResultsOnly 1 of the 14 patients with an acute exacerbation of idiopathic interstitial pneumonia exhibited evidence of respiratory syncytial virus B, and 2 patients exhibited evidence of cytomegalovirus. Seven patients fulfilled the diagnostic criteria of idiopathic pulmonary fibrosis.ConclusionsMost cases with an acute exacerbation of idiopathic interstitial pneumonia are not caused by a viral infection.     

Clinicopathological differences between acute and chronic eosinophilic pneumonia

OBJECTIVE: Considerable confusion exists regarding the proper classification of idiopathic eosinophilic pneumonia (IEP). Furthermore, there are no reports describing the clinicopathological differences between the various forms of eosinophilic pneumonias. METHODOLOGY: The histological findings in acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia (CEP) were examined and the clinical and radiological features were contrasted with them. RESULTS: Radiologically, ground glass opacity and interlobular septal thickening were characteristic of the AEP cases, while air space consolidation was seen in all CEP cases. Histologically, interstitial oedema and fibrin deposition were prominent in the AEP cases. Type II cells were detached from the alveolar walls, although the basal lamina was predominantly intact. In CEP, in addition to cellular infiltration, there was prominent intraluminal fibrosis. Disruption of the basal lamina was observed and nests of intraluminal fibrosis were directly adjacent and connected to the alveolar walls. CONCLUSIONS: An essential histological difference between AEP and CEP is the severity of basal lamina damage and the amount of subsequent intraluminal fibrosis. In AEP particularly, these findings explain the radiographical findings, as well as the rapid and complete improvement noted in such cases.     

GM-CSF-induced acute eosinophilic pneumonia

Summary. There is increasing evidence that haemopoietic growth factors are effective in reversal of neutropenia associated with large granular lymphocytes (LGLs) proliferation. A 19-year-old woman with CD3⁺/TCRγδ⁺, CD4⁻, CD8⁻ LGL proliferation and severe neutropenia repeatedly developed blood eosinophilia, fever and dyspnoea after administration of GM-CSF. Acute eosinophilic pneumonia with a lobar lung infiltrate pleural effusion, and marked bronchoalveolar lavage fluid eosinophilia was diagnosed. Treatment with corticosteroids and discontinuation of GM-CSF lead to rapid improvement. In addition, haematological analysis revealed that H*1 Technicon, a widely-used automated cell counter, may misinterpret eosinophils erroneously as neutrophils, therefore examination of blood smears to prevent eosinophil-medlated toxicity during GM-CSF treatment is recommended.     

特发性非特异性间质性肺炎与普通型间质性炎疾病特征和预后的比较分析

目的 与普通型间质性肺炎(usual interstitial pneumonia,UIP)进行比较分析,探讨特发性非特异性间质性肺炎(idiopathic nonspecific interstitial pneumonia,INSIP)的疾病特征和预后以及与UIP的鉴别诊断.方法 发对经电视胸腔镜或小切口开胸肺活检诊断的21例INSIP患者和18例UIP患者的临床-影像-病理学资料及疗效、预后进行比较分析.结果 INSIP多见于40～50女性,临床表现无特异性,主要表现为活动后气促、咳嗽、咯痰、双下肺可有或无吸气相爆裂音;高分辨率CT(HRCT)表现为双肺弥漫分布的磨玻璃样淡斑片状和不规则网织状阴影,部分可有蜂窝肺.INSIP的病理特征为病变进展相对一致,按病理表现可分为细胞型、纤维化型和混合型.与UIP相比,纤维母细胞灶、肌硬化、镜下蜂窝肺和肺泡结构改建的检出率在INSIP和UIP分别是19.05%和100%(P<0.001),19.05%和88.89%(P<0.05),23.81%和94.44%(P<0.01),33.33%和100%(P<0.01).两者对糖皮质激素的反应率分别为76.19%和38.89%(P<0.01),各型INSIP的预后均明显好于UIP.结论 经 INSIP的一般临床表现差异不明显,HRCT对疑难病例的鉴别诊断有帮助,明确诊断依赖肺活检病理诊断;纤维母细胞灶、伴胶原沉积的瘢痕化和蜂窝变组成不同时相的病变共同构成诊断UIP的形态特征,也是与INSIP的鉴别要点.     

Chronic eosinophilic pneumonia with mucous plugs in a child

Chronic eosinophilic pneumonia is a rare cause of chronic lung disease in children. A 7‐year‐old girl who attended our clinics with cough and sputum lasting for 5 years, has been evaluated for bilateral alveolar infiltration and ground‐glass opacities. Peripheral eosinophilia was detected in total cell blood count. Flexible bronchoscopy showed mucous plugs. Bronchoalveolar lavage fluid and cell block of mucous plugs determined hypereosinophilia. Chronic eosinophilic pneumonia was confirmed after the elimination of other eosinophilic lung diseases and the case was accepted to be idiopathic. She showed a dramatic response to oral corticosteroids. This is the first reported case of chronic eosinophilic pneumonia presenting with mucous plugs in children described to date in the literature. Pediatr Pulmonol. 2010; 45:1040–1042. © 2010 Wiley‐Liss, Inc.     

早期高容量血液滤过持续时间对重症急性胰腺炎急性肺损伤影响研究

目的 研究早期高容量血液滤过(HVHF)持续时间对重症急性胰腺炎(SAP)急性肺损伤(ALI)的影响.方法 将2006年8月到2009年4月怀化市第三人民医院ICU收治的49例入院时合并ALI急性呼吸窘迫综合征(ARDS)并在72 h内接受HVHF治疗的SAP患者随机分为两组.在常规治疗的基础上分别接受血滤持续时间8 h(Ⅰ组)和72 h(Ⅱ组)治疗.比较两组患者的APACHEⅡ评分、氧合指数、ALI/ARDS的改善率(包括治愈率)、机械通气的例数及时间、急性期并发症、HVHF相关并发症、结局及医疗费用等.结果 ①氧合指数及APACHEⅡ评分:两组入院第3天和第14天均较入院当天有所改善(P＜0.05).但在人院第3天和第14天,两组患者差异无统计学意义.②ALI、ARDS的改善率(包括治愈率):两组入院第3天和第14天较入院当天升高(P＜0.05);但在入院第3天和第14天.两组患者差异无统计学意义.③两组患者急性期机械通气的例数及时间、急性期并发症(多器官功能障碍综合征、急性肾功能衰竭、腹腔室隔综合征、导管相关感染、低血压)差异无统计学意义,但医疗费用差异有统计学意义(P＜0.05).两组患者急性期均无死亡.结论 发病72 h内的SAP早期短时(8 h)持续性HVHF治疗能有效促进合并ALI/ARDS的SAP患者肺功能的恢复,并且节约医疗费用.