甲磺酸伊马替尼致间质性肺炎1例并文献复习

目的 提高对甲磺酸伊马替尼所致间质性肺炎的认识,做到早期诊断和治疗,改善患者预后.方法 对北京大学首钢医院呼吸内科诊治的1例甲磺酸伊马替尼致间质性肺炎患者的临床资料进行回顾性分析,并进行相关文献复习.结果 患者女性,小肠间质瘤术后服用甲磺酸伊马替尼3个半月后出现水肿、呼吸困难,入院后胸部CT提示双肺弥漫分布的斑片影,BALF显示细胞总数升高(0.54×109/L),其中淋巴细胞56％.除外感染、自身免疫性疾病和其他药物因素,诊断甲磺酸伊马替尼导致的间质性肺炎,停止服用伊马替尼3周后患者呼吸困难无改善,后加用糖皮质激素治疗,激素治疗约2周后患者呼吸困难明显减轻,胸部CT双肺斑片影较前部分吸收,激素治疗4个月后复查胸部CT病变较前明显吸收,但遗留肺间质纤维化改变,停用激素治疗.随访患者未再服用甲磺酸伊马替尼,2年及5年后胸部CT较前无明显变化,3年后患者因小肠间质瘤复发再次手术切除.结论 服用甲磺酸伊马替尼后出现呼吸困难症状应考虑间质性肺炎可能,早期诊断、停药和应用糖皮质激素治疗可获得显著效果,停药后应长期随访患者基础疾病及肺部情况.通过这此例报道并进行文献复习有助于提高对甲磺酸伊马替尼所致间质性肺炎的认识.

Interstitial pneumonia induced by imatinib mesylate: a case report and literature review

Objective To improve the understanding of the interstitial pneumonia induced by imatinib mesylate,to achieve early diagnosis and treatment and to improve the prognosis of patients.Methods The clinical datas of a patient with interstitial pneumonia induced by imatinib mesylate in the Department of Respiratory Medicine of Peking University Shougang Hospital were retrospectively analyzed and related literatures were reviewed.Results A female patient with small intestinal stromal tumor after operation appeared edema and dyspnea after taking imatinib mesylate for 3 and a half months.The chest CT after admission showed diffnsed distribution of patches in both lung fields.Bronchoalveolar lavage fluid showed elevated total number of cells (0.54 × 109/L) and the percentage of lymphocytes was 56％.Except for the infection,autoimmune diseases and other drug factors,the interstitial pneumonia induced by imatinib mesylate was diagnosed.The patient had no improvement in dyspnea after 3 weeks of discontinuation of imatinib mesylate.Then the patient was given glucocorticoid treatment.After about 2 weeks,her dyspnea was significantly improved and the pulmonary patches of the chest CT were partly absorbed.After 4 months of glucocorticoid treatment the pulmonary lesions of chest CT were significantly absorbed but the change of pulmonary interstitial fibrosis was still left.Then the glucocorticoid treatment was stopped.The patient did not take imatinib mesylate again.There was no obvious change in the chest CT after 2 years and 5 years.Three years later,the patient underwent the second surgery for a recurrence of the small intestinal stromal tumor.Conclusions The appearance of dyspnea after taking imatinib mesylate should be considered the possibility of interstitial pneumonia.Early diagnosis,discontinuation of imatinib mesylate and application of glucocorticoid can get significant effect.Doctors should have long term follow-up to the underlying disease and pulmonary conditions of the patients after discontinuation of imatinib mesylate.Through this case report and literature review,it is helpful to improve the understanding of the interstitial pneumonia induced by imatinib mesylate.