急性间质性肺炎一例并文献复习
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摘要
目的探讨急性间质性肺炎(AIP)的病因、诊断与治疗,提高对该病的认识水平。方法对1例一氧化碳中毒后迟发性脑病患者发生AIP的临床资料进行回顾性分析,并以"急性间质性肺炎"或"acute interstitial pneumonia"为检索词在PubMed、中国期刊全文数据库(CNKI)、万方数据知识服务平台和维普中文科技期刊数据库检索,收集并分析检索到的有详细症状、诊断、治疗、转归的病例资料。结果该例为21岁的一氧化碳中毒后迟发性脑病女性患者,因呼吸衰竭转入内科ICU,经抗感染治疗无效,病理活组织检查(活检)诊断为AIP,予肾上腺皮质激素(激素)、环磷酰胺、机械通气等治疗后好转出院。检索文献后,排除已知AIP诱发因素的病例,157例有详细症状、诊断、治疗、转归的病例资料,其中72例经病理活检确诊。AIP患者的主要临床表现为咳嗽(141例,89.8%)、呼吸困难(130例,82.8%)、发热(79例,50.3%),主要影像学表现为磨玻璃样变(119例,75.8%)、肺实变(37例,23.6%)、弥漫性渗出影(33例,21.0%);主要病理活检表现为Ⅱ型肺泡上皮增生(24例,33.3%)、肺泡纤维化(22例,30.6%)、肺泡间隔增厚(20例,27.8%);使用大剂量激素治疗44例(28.0%),联合免疫抑制剂治疗12例(7.6%),行机械通气100例(63.7%);体外膜肺氧合(4例,2.5%);共57例(36.3%)患者好转出院,100例(63.7%)患者死亡。结论 AIP是一种病因未明、起病急骤、以呼吸衰竭为主的间质性肺炎,目前无疗效确切的治疗方法,早期激素治疗可能有效,临床预后差。
Objective To analyze the pathogenesis,diagnosis and treatment of acute interstitial pneumonia(AIP) and deepen the understanding of AIP.Methods Clinical data of one patient with delayed encephalopathy suffering from AIP after carbonic oxide poisoning were retrospectively analyzed. A comprehensive literature search was performed in PubMed,China Journal Full-text Database(CNKI),Wanfang Data and Chongqing Vip database using the keywords of "acute interstitial pneumonia" in both English and Chinese. Detailed clinical data including symptoms,diagnosis,treatment and outcomes of patients with AIP were collected and analyzed.Results The 21-year-old female patient diagnosed with delayed encephalopathy was transferred to the MICU due to respiratory failure after carbonic oxide poisoning. She was not effectively treated after antibiotic therapy. She was diagnosed with AIP by pathological tissue examination(lung biopsy), Then,the patient was treated with steroid,cyclophosphamide,and mechanical ventilation. She was recovered and discharged. After excluding patients whose inducing factors of AIP have been identified,detailed symptoms,diagnosis,treatment and outcomes were collected from 157 AIP patients,and 72 cases of them were confirmed by pathological biopsy. The clinical manifestations of AIP patients mainly included cough(n=141,89.8%),dyspnea(n=130,82.8%) and fever(n=79,50.3%). The main imaging findings consisted of ground glass changes(n=119,75.8%),pulmonary consolidation(n=37,23.6%) and diffuse exudative lesions(n=33,21.0%).The dominant pathological findings were type Ⅱ alveolar epithelial hyperplasia(n=24,33.3%),alveolar fi-brosis(n=22,30.6%) and thickening of alveolar septum(n=20,27.8%). Forty-four cases(28.0%)were treated with high-dose hormone therapy,12(7.6%) were supplemented with immunosuppressive agents,100(63.7%) received mechanical ventilation and 4 cases were treated with ECMO(2.5%). A total of 57 patients(36.3 %) were recovered and discharged, whereas 100 patients(63.7%) died.Conclusions AIP is a category of interstitial lung disease with unknown pathogenesis,urgent onset which rapidly develops in-to respiratory failure. At present,there is no exactly effective treatment. Early steroid therapy may be beneficialto patients,but the clinical prognosis of AIP patients is rather poor.
Objective To analyze the pathogenesis,diagnosis and treatment of acute interstitial pneumonia(AIP) and deepen the understanding of AIP.Methods Clinical data of one patient with delayed encephalopathy suffering from AIP after carbonic oxide poisoning were retrospectively analyzed. A comprehensive literature search was performed in PubMed,China Journal Full-text Database(CNKI),Wanfang Data and Chongqing Vip database using the keywords of "acute interstitial pneumonia" in both English and Chinese. Detailed clinical data including symptoms,diagnosis,treatment and outcomes of patients with AIP were collected and analyzed.Results The 21-year-old female patient diagnosed with delayed encephalopathy was transferred to the MICU due to respiratory failure after carbonic oxide poisoning. She was not effectively treated after antibiotic therapy. She was diagnosed with AIP by pathological tissue examination(lung biopsy), Then,the patient was treated with steroid,cyclophosphamide,and mechanical ventilation. She was recovered and discharged. After excluding patients whose inducing factors of AIP have been identified,detailed symptoms,diagnosis,treatment and outcomes were collected from 157 AIP patients,and 72 cases of them were confirmed by pathological biopsy. The clinical manifestations of AIP patients mainly included cough(n=141,89.8%),dyspnea(n=130,82.8%) and fever(n=79,50.3%). The main imaging findings consisted of ground glass changes(n=119,75.8%),pulmonary consolidation(n=37,23.6%) and diffuse exudative lesions(n=33,21.0%).The dominant pathological findings were type Ⅱ alveolar epithelial hyperplasia(n=24,33.3%),alveolar fi-brosis(n=22,30.6%) and thickening of alveolar septum(n=20,27.8%). Forty-four cases(28.0%)were treated with high-dose hormone therapy,12(7.6%) were supplemented with immunosuppressive agents,100(63.7%) received mechanical ventilation and 4 cases were treated with ECMO(2.5%). A total of 57 patients(36.3 %) were recovered and discharged, whereas 100 patients(63.7%) died.Conclusions AIP is a category of interstitial lung disease with unknown pathogenesis,urgent onset which rapidly develops in-to respiratory failure. At present,there is no exactly effective treatment. Early steroid therapy may be beneficialto patients,but the clinical prognosis of AIP patients is rather poor.
引文
[1]尹睿,王新安,欧阳修河,郑文涛,于立萍.急性间质性肺炎1例.新医学,2006,37(4):280.
[2]Salim MU,Mustahsan SM,Fatima A.Abruptio placentae with typeⅡeespiratory failure secondary to acute interstitial pneumonia responsive to steroids.J Coll Physicians Surg Pak,2017,27(9):S106-S107.
[3]Travis WD,Costabel U,Hansell DM,King TE Jr,Lynch DA,Nicholson AG,Ryerson CJ,Ryu JH,Selman M,Wells AU,Behr J,Bouros D,Brown KK,Colby TV,Collard HR,Cordeiro CR,Cottin V,Crestani B,Drent M,Dudden RF,Egan J,Flaherty K,Hogaboam C,Inoue Y,Johkoh T,Kim DS,Kitaichi M,Loyd J,Martinez FJ,Myers J,Protzko S,Raghu G,Richeldi L,Sverzellati N,Swigris J,Valeyre D;ATS/ERSCommittee on Idiopathic Interstitial Pneumonias.An official American Thoracic Society/European Respiratory Society statement:update of the international multidisciplinary classification of the idiopathic interstitial pneumonias.Am J Respir Crit Care Med,2013,188(6):733-748.
[4]李珍,黄晓峰,任东青.一氧化碳中毒所致肺组织病理改变.中华临床医师杂志(电子版),2013,7(18):8438-8440.
[5]范丹峰,肖宏,潘树义.急性重度一氧化碳中毒肺水肿13例临床救治体会.中华航海医学与高气压医学杂志,2017,24(1):65-68.
[6]Fan D,Lv Y,Hu H,Pan S.Severe pulmonary edema following hyperbaric oxygen therapy for acute carbon monoxide poisoning:a case report and clinical experience.Undersea Hyperb Med,2017,44(3):287-291.
[7]潘爱军,金魁,周树生,李矗,沈建军,刘宝.高压氧对油酸诱导大鼠急性肺损伤作用的实验研究.中国危重病急救医学,2010,22(7):422-425.
[8]Taniguchi H,Kondoh Y.Acute and subacute idiopathic interstitial pneumonias.Respirology,2016,21(5):810-820.
[9]张韬军,乔英,李健丁.急性间质性肺炎的CT表现及其病理学基础.中国中西医结合影像学杂志,2015,13(6):683-685.
[10]Ichikado K.High-resolution computed tomography findings of acute respiratory distress syndrome,acute interstitial pneumonia,and acute exacerbation of idiopathic pulmonary fibrosis.Semin Ultrasound CT MR,2014,35(1):39-46.
[11]吴爽,任锦,李艳秋,尹金植.急性间质性肺炎1例报道及文献复习.中国实验诊断学.2017,21(1):34-35.
[12]Avnon LS,Pikovsky O,Sion-Vardy N,Almog Y.Acute interstitial pneumonia-Hamman-Rich syndrome:clinical characteristics and diagnostic and therapeutic considerations.Anesth Analg,2009,108(1):232-237.
[13]Quefatieh A,Stone CH,DiGiovine B,Toews GB,Hyzy RC.Low hospital mortality in patients with acute interstitial pneumonia.Chest,2003,124(2):554-559.
[14]Ichikado K,Suga M,Müller NL,Taniguchi H,Kondoh Y,Akira M,Johkoh T,Mihara N,Nakamura H,Takahashi M,Ando M.Acute interstitial pneumonia:comparison of high-resolution computed tomography findings between survivors and nonsurvivors.Am J Respir Crit Care Med,2002,165(11):1551-1556.
[15]陈文恭,刘娇,姚建英,陈德昌,叶剑鸿.22例急性间质性肺炎的诊治分析.武汉大学学报(医学版),2013,34(4):614-617.
[16]Gon?alves-Venade G,Lacerda-Príncipe N,Roncon-Albuquerque R Jr,Paiva JA.Extracorporeal membrane oxygenation for refractory severe respiratory failure in acute interstitial pneumonia.Artif Organs,2018,42(5):569-574.
[2]Salim MU,Mustahsan SM,Fatima A.Abruptio placentae with typeⅡeespiratory failure secondary to acute interstitial pneumonia responsive to steroids.J Coll Physicians Surg Pak,2017,27(9):S106-S107.
[3]Travis WD,Costabel U,Hansell DM,King TE Jr,Lynch DA,Nicholson AG,Ryerson CJ,Ryu JH,Selman M,Wells AU,Behr J,Bouros D,Brown KK,Colby TV,Collard HR,Cordeiro CR,Cottin V,Crestani B,Drent M,Dudden RF,Egan J,Flaherty K,Hogaboam C,Inoue Y,Johkoh T,Kim DS,Kitaichi M,Loyd J,Martinez FJ,Myers J,Protzko S,Raghu G,Richeldi L,Sverzellati N,Swigris J,Valeyre D;ATS/ERSCommittee on Idiopathic Interstitial Pneumonias.An official American Thoracic Society/European Respiratory Society statement:update of the international multidisciplinary classification of the idiopathic interstitial pneumonias.Am J Respir Crit Care Med,2013,188(6):733-748.
[4]李珍,黄晓峰,任东青.一氧化碳中毒所致肺组织病理改变.中华临床医师杂志(电子版),2013,7(18):8438-8440.
[5]范丹峰,肖宏,潘树义.急性重度一氧化碳中毒肺水肿13例临床救治体会.中华航海医学与高气压医学杂志,2017,24(1):65-68.
[6]Fan D,Lv Y,Hu H,Pan S.Severe pulmonary edema following hyperbaric oxygen therapy for acute carbon monoxide poisoning:a case report and clinical experience.Undersea Hyperb Med,2017,44(3):287-291.
[7]潘爱军,金魁,周树生,李矗,沈建军,刘宝.高压氧对油酸诱导大鼠急性肺损伤作用的实验研究.中国危重病急救医学,2010,22(7):422-425.
[8]Taniguchi H,Kondoh Y.Acute and subacute idiopathic interstitial pneumonias.Respirology,2016,21(5):810-820.
[9]张韬军,乔英,李健丁.急性间质性肺炎的CT表现及其病理学基础.中国中西医结合影像学杂志,2015,13(6):683-685.
[10]Ichikado K.High-resolution computed tomography findings of acute respiratory distress syndrome,acute interstitial pneumonia,and acute exacerbation of idiopathic pulmonary fibrosis.Semin Ultrasound CT MR,2014,35(1):39-46.
[11]吴爽,任锦,李艳秋,尹金植.急性间质性肺炎1例报道及文献复习.中国实验诊断学.2017,21(1):34-35.
[12]Avnon LS,Pikovsky O,Sion-Vardy N,Almog Y.Acute interstitial pneumonia-Hamman-Rich syndrome:clinical characteristics and diagnostic and therapeutic considerations.Anesth Analg,2009,108(1):232-237.
[13]Quefatieh A,Stone CH,DiGiovine B,Toews GB,Hyzy RC.Low hospital mortality in patients with acute interstitial pneumonia.Chest,2003,124(2):554-559.
[14]Ichikado K,Suga M,Müller NL,Taniguchi H,Kondoh Y,Akira M,Johkoh T,Mihara N,Nakamura H,Takahashi M,Ando M.Acute interstitial pneumonia:comparison of high-resolution computed tomography findings between survivors and nonsurvivors.Am J Respir Crit Care Med,2002,165(11):1551-1556.
[15]陈文恭,刘娇,姚建英,陈德昌,叶剑鸿.22例急性间质性肺炎的诊治分析.武汉大学学报(医学版),2013,34(4):614-617.
[16]Gon?alves-Venade G,Lacerda-Príncipe N,Roncon-Albuquerque R Jr,Paiva JA.Extracorporeal membrane oxygenation for refractory severe respiratory failure in acute interstitial pneumonia.Artif Organs,2018,42(5):569-574.