结缔组织病合并肺间质病变临床分析

目的 探讨结缔组织病合并肺间质病变的临床特点.方法 对46例结缔组织病合并肺间质病变的临床表现、实验室检查、肺功能检测、血气分析、影像学改变、治疗与转归进行回顾性分析.结果 结缔组织病合并肺间质病变的患者初始临床表现以原发疾病症状多见;红细胞沉降率升高者35例,类风湿因子升高者31例,ANCA阳性者34例;11例行肺功能检测7例存在限制性通气功能障碍和(或)弥散功能降低;不同程度的低氧血症;胸部CT显示网格状影、蜂窝肺、磨玻璃样等改变;经治疗1例死于严重感染,2例死于呼吸衰竭.结论 结缔组织病合并肺间质病变可以原发结缔组织疾病或呼吸系统表现为首发症状,影像学改变是临床诊断的依据.早期诊治是改善此类患者预后的重要手段.     

类风湿性关节炎并发肺间质病变30例临床分析

目的：探讨类风湿性关节炎（RA）并发肺闻质病变（ILD）的发生情况、临床特点、肺功能、影像学检查及相关因素,加深对RA肺间质病变的认识。方法：回顾我院2006年3月～2009年3月90例住院RA患者的临床资料,包括类风湿性因子（RF）、血气分析、胸部X线、肺高分辨CT（HRCT）、肺功能检查等,分析RA并发肺间质病变患者的特点。结果：本组类风湿关节炎患者中并发肺间质病变30例;经过适当的治疗,病情一般能够得到解决控制,只有2例死亡,占6．7％,死亡原因为Ⅰ型呼吸衰竭。结论：患者呼吸系统病患出现在关节炎之后,肺间质病变的发生与重症类风湿关节炎有关联,但病情较原发性肺病变轻,RA患者应尽早做肺HRCT及肺功能检查,以早期诊断和治疗肺部病变,尤其是RF强阳性的RA患者。     

10例全身型幼年特发性关节炎伴肺间质病变的影像学表现分析

目的了解全身型幼年特发性关节炎伴肺间质病变（SOJIA-ILD）的发生率及影像学改变。方法对46例全身型幼年特发性关节炎（SOJIA）患儿进行胸部X线和肺高分辨率CT（HRCT）检查,分析其影像表现的改变。结果影像学确诊SOJIA-ILD患儿10例,占21.7%,30.0%（3/10）的出现呼吸系统症状或阳性体征;肺HRCT诊断SOJIA-ILD优于胸片,可将SOJIA-ILD患儿分为临床前期型8例（80%）,急性肺泡炎型2例（20%）,未发现有慢性肺间质病变型的病例。结论SOJIA-ILD的发生在儿童中并不少见,肺HRCT对发现早期肺间质病变、临床分型及预后判断和治疗具有指导意义。     

1例职业性铟化合物中毒病例分析

对1例职业性铟暴露患者职业接触史、临床症状、病情演变、病理改变、影像学特点以及肺功能检查等资料结合现场调查进行综合分析。探讨职业性铟暴露患者肺间质病变的致病原因和鉴别诊断等问题。     

HIV/AIDS相关性卡氏肺囊虫肺炎的临床特征和影像诊断

目的探讨HIV/AIDS相关性卡氏肺囊虫肺炎的临床特征和影像学征象.方法收集在援博茨瓦纳玛丽娜公主医院临床及病理证实的卡氏肺囊虫肺炎132例,血液HIV抗体检查均为阳性,对其临床特点、病理机制和影像征象进行综合分析.结果卡氏肺囊虫肺炎以干咳、呼吸困难和低热为典型症状而体征不明显,CD4计数通常＜200/μl;典型的影像学表现为两侧肺门到肺周围弥漫对称性的渗出性病变,分布于肺门周围,呈毛玻璃改变,病灶由肺门向周围肺野发展且呈明显的融合趋势.结论卡氏肺囊虫肺炎是HIV/AIDS常见的肺部机会性感染,典型的胸部影像学表现和明显的临床症状而体征轻微者,排除其他原因导致的免疫缺乏性疾病外,经血液检查证实HIV抗体阳性者应积极治疗,尽快获得病理学证据,高分辨率胸部CT扫描显示肺内浸润和肺气囊等病变明显强于X线平片.     

慢性阻塞性肺疾病肺间质性纤维化CT改变与肺功能分级的对比研究

目的 探讨慢性阻塞性肺疾病肺间质性纤维化的CT改变与肺功能分级的对比情况.方法 按照患者的肺功能进行分级,再对患者应用CT进行检查,观察各组患者的影像学改变.结果 在肺功能的各个分级中,小叶间隔增厚、支气管血管束增粗、肺内异常线影发生率较高.结论 慢性阻塞性肺疾病肺间质性纤维化患者在疾病的早期已经有影像学上的改变,可以作为疾病诊断的依据,并且以小叶间隔增厚、支气管血管束增粗、肺内异常线影发生率较高,在临床的疾病诊断过程中值得重视并广泛应用.     

25例矽肺病人血气及脑电图改变分析

矽肺病人临床上常以咳嗽、咳痰、胸闷、气急为常见症状。主要是由于长期吸入含有游离二氧化硅的粉尘,而引起的全身性疾病。其主要表现为肺内广泛结节病变及肺间质纤维化,严重者将产生肺功能不全。现将我院收治的25例矽肺病人的血气及脑电图改变的分析如下:     

眼部筛窦横纹肌肉瘤CT及MRI影像学结果分析探讨

目的：提高对筛窦横纹肌肉瘤影像学表现及正确诊断的认识。方法：结合病理学及免疫组织化学检查结果,回顾分析4例筛窦横纹肌肉瘤的影像学表现。结果：病理学及免疫组织化学检查结果证实,4例患者中有3例为腺泡性横纹肌肉瘤,1例为胚胎性横纹肌肉瘤。CT和MRI影像学检查显示,病变以膨胀性生长为主,病变区域密度（信号）不均匀,增强扫描出现明显不均匀强化;病变组织对周围结构,如眼眶、鼻窦、鼻腔、前颅底等常有侵犯;骨质改变多以压迫性骨质吸收和溶骨型骨质吸收并存为主。结论：CT可以显示骨质的破坏程度和病变范围,MRI可以更清晰地显示病变侵犯的范围,而CT及MRI联合检查有助于准确判断筛窦横纹肌肉瘤的病变范围及侵犯范围。     

肺泡蛋白沉积症影像诊断的病理基础及临床应用研究

目的研究肺泡蛋白沉积症(PAP)影像诊断的病理基础及临床应用价值。方法回顾性分析经支气管肺泡灌洗(BAL)或开胸肺活检证实9例PAP的临床、病理及影像资料,并探讨其影像征象的病理学基础及影像诊断的临床应用价值。结果9例PAP的影像表现主要为双肺弥漫且对称分布的腺泡结节影、斑片影、线状影、网状影、磨玻璃影及大片状非叶段性阴影。组织病理学上见病变肺泡腔及小气道内部分或完全充填以PAS染色阳性物质,从而形成磨玻璃影及实变影;而病变肺组织与正常肺组织或肺气肿混合并存,是典型地图样改变的基本原因;病变区间质炎症及水肿致间隔系统增厚,从而使病变表现出为三角形、多角形及不规则形影,因此为HRCT上产生典型铺路石样改变的病理基础。结论PAP的临床表现虽无特异性,但其特征性病理改变是典型影像学表现的基础,因而影像检查可以有效地缩小临床进一步确诊的范围。     

纤维支气管镜肺活检在尘肺诊断中的价值

目的探讨经纤维支气管镜肺活检在尘肺诊断中的价值。方法对2008年1月至2010年6月有粉尘接触者共171例接受纤维支气管镜肺活检(TBLB)、支气管肺泡灌洗(BAL)、支气管刷检,对细菌学、细胞学及病理学检查结果,并结合职业卫生、临床、影像学检查等进行了回顾性分析。结果本组171例受检者中169例获得了合格肺组织标本,其中166例有肺间质纤维化改变(139例检查出成纤维细胞增生,99例胶原纤维形成),120例有粉尘沉着,40例偏光镜检查阳性,48例普鲁士蓝铁染色阳性。结合职业健康监护、临床、影像学等资料综合分析后,对照尘肺病诊断标准片确诊各类职业性尘肺病162例,无尘肺7例。结论经纤维支气管镜肺活检在尘肺病的诊断及鉴别诊断中有较高的应用价值。     

Evaluation of workers exposed to dust containing hard metals and aluminum oxide

Background Fourteen workers exposed to hard metals and aluminum oxide were evaluated. Methods Six heavily exposed workers underwent bronchoscopy and bronchoalveolar lavage, and five workers underwent transbronchial biopsy. Results Microchemical analysis of transbronchial biopsies showed a high lung burden of exogenous particles, especially metals related to their hard metals exposure. Lung tissue and cellular changes, which were associated with exposure to hard metal and aluminum oxide, corresponded well with the microanalytic test results. Conclusions Three workers had at biopsy diffuse interstitial inflammatory changes: two of them were asymptomatic with normal chest X-ray films, and one had clinically evident disease with severe giant cell inflammation. Two other workers showed focal inflammation. The worker showing clinical disease and one asymptomatic worker with interstitial inflammatory changes had elevated bronchoalveolar lavage fluid-eosinophilia counts. These two were father (with clinical disease) and son (asymptomatic). Am. J. Ind. Med. 34:177–182, 1998. © 1998 Wiley-Liss, Inc.     

对于慢阻肺与肺间质纤维化54例临床分析

目的探讨并分析慢阻肺和肺间质纤维化的临床发展。方法回顾性分析我院于2012年4月-2014年4月所收治的54例慢阻肺患者的临床资料,同时对32例患者经纤支镜去肺组织中进行活检、实施免疫病理、光镜以及电镜研究,对肺纤维化临床特点、病理以及超微结构特点实施总结。结果经检查研究发现,提示有肺纤维化倾向为慢阻肺发展的一个必然趋势与病理结局。结论从本次研究的结果来看,大部分慢阻肺患者在临床、肺功能以及胸片等方面均有肺间质纤维化特征性改变,于慢阻肺发展期间,因合并有弥漫性肺间质纤维化,使得肺脏顺应性逐步减低,导致肺活量急剧降低,严重影响着肺功能以及预后。由此可见,探讨分析慢阻肺与肺间质纤维化的临床发展,对于肺心病的预防和治疗有着非常重要的意义。     

胸内结节病的MSCT诊断与鉴别诊断

目的 探讨胸内结节病的CT表现,提高对胸内结节病的影像学认识.方法 采用GEPROSPEED FⅡ双排CT机,回顾性分析近年来收集到的10例结节病患者的MSCT表现,全部病人均行常规平扫及增强扫描.所有病人经临床规范激素治疗有效或活检证实.结果 10例中3例为双侧肺门淋巴结肿大,6例为肺门淋巴结肿大伴肺内间质改变,1例...     

Pheasant rearer's lung

A 47-year-old gamekeeper presented with an 8 month history of variable breathlessness, cough and clinical features of severe interstitial lung disease. Open lung biopsy showed an extrinsic allergic alveolitis, which we believe related to his work rearing pheasants. Initially he was resistant, despite advice, to changing his occupation but subsequently, although ceasing exposure to pheasants and beginning treatment with corticosteroids, his disease progressed to the point where he developed respiratory failure and was referred for lung transplantation. Sadly, he died of progressive respiratory failure and cor pulmonale complicated by bronchopneumonia before this could be achieved.     

慢性阻塞性肺疾病合并肺间质纤维化的临床研究

目的分析慢性阻塞性肺疾病合并肺间质纤维化（IPF—COPD）的特点并探讨其临床意义。方法分析6年来我院发现的28例PIF-COPD患者的病史、临床表现、X线胸片、肺高分辫率CT（HR—CT）、血气分析和肺功能检查结果。结果PIF—COPD的临床表现介于上述两种疾病,常有长期大量吸烟史。X线胸片、HRCT兼有两种疾病的特点。其肺功能多为混合性通气功能障碍,一氧化碳弥散量（DLCO）多为中重度下降。血气以低氧血症为主,部分合并有二氧化碳潴留。结论COPD和IPF是两种不同疾病,但可以同时存在,其临床表现具有独特性。肺功能检查、血气分析、X线胸片和肺CT．尤其肺HR—CT可为确诊提供依据。     

Treatment and results of interstitial lung diseases in video assisted thoracoscopic lung biopsy

In order to establish treatment of interstitial lung diseases in video assisted thoracoscopic lung biopsy, we retrospectively reviewed our experiences. The present study included 7 patients with a mean age of 46.4, range from 24 to 61, who were treated at our department from 1996 through 1999. They were 5 men and 2 women. The pathologic diagnosis was nonspecific interstitial pneumonia in 3 patients who responded to steroid therapy. Three other patients had usual interstitial pneumonia. One patient had lymphocytic interstitial pneumonia. No complications occurred. The results indicate that video assisted thoracoscopic lung biopsy is an effective and safe way to diagnose interstitial lung diseases.     

皮肌炎/多发性肌炎合并间质性肺炎的临床研究

目的：研究皮肌炎/多发性肌炎（DM/PM）合并间质性肺炎的临床特点。方法：对比分析10例DM/PM合并间质性肺炎及26例特发性肺纤维化（IPF）患者的症状、体征、X线胸片、胸部高分辨CT(HRCT)、肺功能、动脉血气结果。结果：DM/PM合并间质性肺炎发病年龄较IPF年轻，发病至就诊时间明显较后者短。两组都有不同程度的低氧血症，无二氧化碳潴留。肺功能检查：以限制为主，均有弥散功能降低。结论：DM/PM合并间质性肺炎发病年龄较IPF年轻，病程较短，存活时间短，预后差。     

Persistent tachypnea in infants: possibly due to interstitial pneumonitis

In three male infants aged 3, 4.5 and 11 months with tachypnea and feeding problems, the initial supplementary examination revealed no possible cause. The tissue obtained by open lung biopsy showed interstitial pneumonia/pneumonitis. The two youngest patients were treated with hydrochloroquine and prednisone; the youngest died at the age of 18 months. Both the infant who was maintained on hydrochloroquine and the one who did not receive treatment showed a normal respiratory frequency and growth during the following years. Tachypnea is less easily recognised in infants than in older patients. It may be the only early symptom of interstitial pneumonitis. A normal chest X-ray cannot exclude an incipient interstitial pneumonitis as the cause of the tachypnea. A high-resolution CT-scan of the lung parenchyma is necessary in order to detect the disease at an early stage. Histological examination of an open lung biopsy specimen is essential for the specific diagnosis, therapy and prognosis.     

Open lung biopsy in severely ill patients with unrecognized pulmonary infiltrates

In three patients, a man aged 34 with aids, a woman aged 67 with recurrent major dyspnoea and a woman aged 73 with chronic lymphatic leukaemia, examination revealed progressive dyspnoea while the chest X-rays showed infiltrative lesions in both lungs. In view of the inadequate response to the treatment administered, an open lung biopsy was performed, following which the diagnosis could be made. Adequate treatment was then started and followed by clinical recovery. It is not clear if open lung biopsy carries higher risks of mortality and morbidity than biopsy by means of flexible bronchoscopy. Open lung biopsy more often leads to a classifying diagnosis. For collection of endobronchial or transbronchial biopsy samples in ununderstood diffuse interstitial lung diseases, flexible bronchoscopy is the method of first choice. Open lung biopsy is a justified supplementary examination, at any rate in severely ill, immunocompromised patients who require adequate therapy without delay.