慢性嗜酸粒细胞肺炎临床诊治研究进展

慢性嗜酸粒细胞肺炎是一种少见的病因不明的嗜酸粒细胞肺疾病,以嗜酸粒细胞在肺中聚集为特征。慢性嗜酸粒细胞肺炎临床表现多不典型,误诊率高。本文从定义、临床表现、诊断、治疗及预后对该病作一综述,以提高对其的认识。     

慢性嗜酸粒细胞肺炎的研究进展

慢性嗜酸粒细胞肺炎是一种病因不明的慢性肺嗜酸粒细胞性炎症,临床表现无特异性,其特点为周围性肺浸润影;外周血和(或)支气管肺泡灌洗液中嗜酸粒细胞数显著增高;抗感染治疗无效而对糖皮质激素的反应良好,但在减量或停用糖皮质激素时容易复发.     

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。     

慢性嗜酸粒细胞肺炎1例并文献复习

目的 介绍1例慢性嗜酸粒细胞肺炎(CEP)并复习近7年的9篇国内文献报道共10例,以提高对这一少见病的认识.方法 对1例确诊为CEP患者的临床及随访资料进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 CEP是一种病因不明的慢性肺嗜酸粒细胞性炎症.其特点为患者可有过敏性疾病史,多数患者有咯痰、发热、不同程度的呼吸困难,部分患者可以阴性,而在体检时发现.外周血嗜酸粒细胞及红细胞沉降率大部分明显增高,胸部X线片呈肺外周非肺段分布性进展性高密度浸润影,常有肺水肿反向征,痰和(或)支气管肺泡灌洗液嗜酸粒细胞显著增高,抗感染治疗无效,而对口服糖皮质激素(OSCT)反应良好.OSCT治疗后阴影迅速吸收,总的预后良好.结论 对具有以上特征且抗生素治疗无效的肺炎患者,应疑诊CEP,及时行支气管肺泡灌洗嗜酸粒细胞计数或经皮肺活检可以明确诊断.     

慢性嗜酸粒细胞肺炎1例并文献复习

目的 介绍1例慢性嗜酸粒细胞肺炎(CEP)并复习近7年的9篇国内文献报道共10例,以提高对这一少见病的认识.方法 对1例确诊为CEP患者的临床及随访资料进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 CEP是一种病因不明的慢性肺嗜酸粒细胞性炎症.其特点为患者可有过敏性疾病史,多数患者有咯痰、发热、不同程度的呼吸困难,部分患者可以阴性,而在体检时发现.外周血嗜酸粒细胞及红细胞沉降率大部分明显增高,胸部X线片呈肺外周非肺段分布性进展性高密度浸润影,常有"肺水肿反向征",痰和(或)支气管肺泡灌洗液嗜酸粒细胞显著增高,抗感染治疗无效,而对口服糖皮质激素(OSCT)反应良好.OSCT治疗后阴影迅速吸收,总的预后良好.结论 对具有以上特征且抗生素治疗无效的肺炎患者,应疑诊CEP,及时行支气管肺泡灌洗嗜酸粒细胞计数或经皮肺活检可以明确诊断.     

慢性嗜酸粒细胞肺炎1例并文献复习

目的 介绍1例慢性嗜酸粒细胞肺炎(CEP)并复习近7年的9篇国内文献报道共10例,以提高对这一少见病的认识.方法 对1例确诊为CEP患者的临床及随访资料进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 CEP是一种病因不明的慢性肺嗜酸粒细胞性炎症.其特点为患者可有过敏性疾病史,多数患者有咯痰、发热、不同程度的呼吸困难,部分患者可以阴性,而在体检时发现.外周血嗜酸粒细胞及红细胞沉降率大部分明显增高,胸部X线片呈肺外周非肺段分布性进展性高密度浸润影,常有"肺水肿反向征",痰和(或)支气管肺泡灌洗液嗜酸粒细胞显著增高,抗感染治疗无效,而对口服糖皮质激素(OSCT)反应良好.OSCT治疗后阴影迅速吸收,总的预后良好.结论 对具有以上特征且抗生素治疗无效的肺炎患者,应疑诊CEP,及时行支气管肺泡灌洗嗜酸粒细胞计数或经皮肺活检可以明确诊断.     

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...     

慢性阻塞性肺疾病患者血嗜酸粒细胞分布及临床特征

目的:分析社区与门诊慢性阻塞性肺疾病（慢阻肺）患者的血嗜酸粒细胞（EOS）分布,并研究高EOS型慢阻肺患者的临床特征和相关因素。方法:本研究纳入237例稳定期慢阻肺患者,其中男193例,女44例,年龄范围58~76岁,中位数为68岁,45例来源于2012—2013年“中国成人肺部健康”流行病学调查获取的社区患者,192...     

肺部疾病中嗜酸粒细胞的细胞因子控制

本对嗜酸粒细胞及其细胞因子在支气管哮喘和慢性阻塞性肺疾患等主要肺部疾病中的产生及其作用作一综述。     

慢性嗜酸粒细胞性肺炎9例临床分析

目的:分析慢性嗜酸粒细胞性肺炎（CEP）的临床特征、治疗转归等要点,提高临床诊治能力。方法:回顾性收集山东省千佛山医院2014年1月至2020年12月诊断为CEP的9例患者的临床资料,并进行随访。结果:9例患者中男1例,女8例,年龄16~71岁,中位年龄47岁。5例合并支气管哮喘,1例合并过敏性鼻炎,1例有花粉过敏史。...     

Tracheobronchial lesions in eosinophilic pneumonia

BackgroundEosinophilic pneumonia (EP) is characterized by eosinophil infiltration in the lung parenchyma. However, tracheobronchial lesions associated with the disease have been poorly described. To clarify the frequency and characteristics of cases with tracheobronchial lesions in EP, we performed a retrospective review of EP patients.MethodsWe included 36 EP cases seen from January 2004 to December 2007 at the Kinki-Chuo Chest Medical Center. The incidence of tracheobronchial nodules and associated clinical features were analyzed.ResultsOf these 36 patients, 29 had chronic eosinophilic pneumonia (CEP); 1, acute EP; 3, drug-induced EP; 2, allergic bronchopulmonary aspergillosis; and 1, parasite-related EP. Only 2 of the 29 CEP cases had tracheobronchial lesions. For both of these cases, bronchoscopy revealed multiple whitish nodules on the tracheobronchial mucosa. The associated histopathological findings revealed squamous metaplasia and eosinophil infiltration in the subepithelial region. In both cases, the nodules disappeared after steroid therapy. The prevalence of tracheobronchial lesions was 6.9% in CEP patients and 5.6% in EP patients overall. EP patients were divided into 3 groups: CEP with nodules (n=2), CEP without nodules (n=27), and other EP (n=7). We found that the CEP with nodules group showed a relatively higher incidence of respiratory symptoms, higher white blood cell (WBC) count, and higher levels of peripheral and bronchoalveolar eosinophilia than the other groups.ConclusionsTracheobronchial nodules represent rare observations within the EP population, which are likely to reflect a severe disease condition.     

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.     

Bronchial involvement in chronic eosinophilic pneumonia: a case report

Chronic eosinophilic pneumonia (CEP) is an idiopathic chronic condition characterized by alveolar filling with mixed inflammatory infiltrate consisting largely of eosinophils. On CT, it is usually observed as consolidation, often peripheral and patchy in distribution, with upper lobe dominance. Airway involvement in CEP is very rare. We report on a case of bronchial involvement in CEP.     

Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia

BackgroundChronic eosinophilic pneumonia (CEP) is an idiopathic disorder characterised by an abnormal and marked accumulation of eosinophils in the interstitium and alveolar spaces of the lungs. Systemic corticosteroid (CS) therapy leads to marked improvement. However, relapse is common in the clinical course, and the predictive factors for relapse of CEP are not well known. This study aimed to investigate predictive factors for relapse in CS-treated cases of CEP.MethodsWe identified consecutive patients with CEP at our institution between 1999 and 2019. We retrospectively reviewed 36 CS-treated patients with CEP who underwent bronchoalveolar lavage (BAL) and high-resolution computed tomography (CT) at diagnosis. We examined relapse at least 1 year after the initiation of CS treatment. Statistical analysis included univariate and multivariate Cox proportional hazard regression analyses; P<0.05 was considered statistically significant.ResultsThe median (interquartile range) age at diagnosis was 59.5 years (47.8–70.0 years). This study included 13 men and 23 women. Twenty-five patients (69.4%) were never smokers and 15 (41.7%) had asthma. The peripheral blood eosinophil percentage was 35.0% (15.6–55.8%), and the BAL eosinophil percentage was 40.8% (10.7–68.5%). The median serum surfactant protein-D (SP-D) level was 135 ng/mL (82.2–176.7 ng/mL). High-resolution CT revealed centrilobular opacities in 23 patients (63.9%). Relapse of CEP was observed in 20 patients (55.6%). Higher serum SP-D levels and the presence of centrilobular opacities on high-resolution CT were significant predictors of relapse in multivariate Cox proportional hazard regression analysis (P=0.017 and P=0.028, respectively). Additionally, we devised a relapse prediction model for CS-treated CEP using two categorical parameters: the presence of centrilobular opacities and serum levels of SP-D (>135/≤135 ng/mL). Based on these parameters, cases were scored 2, 1, or 0. Patients with a score of 2 experienced relapses earlier than those with scores of 1 and 0 (log-rank test; P=0.006, P=0.003, respectively).ConclusionsCentrilobular opacities on high-resolution CT and higher serum SP-D levels at diagnosis may be predictive factors for relapse in CS-treated patients with CEP.     

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.