过敏性肺泡炎2例

<正>外源性过敏性肺泡炎(EAA)又名过敏性肺泡炎,是指易感者暴露于某些有机分子引起一系列复杂炎症反应而表现出的一组临床综合征〔1〕。近年来随着种植、养殖、化工等行业的发展,EAA的发病率逐年上升。1临床资料1.1病例1患者64岁女性,因咳嗽、渐进性呼吸困难2个月,胸闷气短1个月入院。养鸽史(近百只)10年。于当地医院行胸部CT提示双肺多发斑片状密度影、呈磨玻璃样,给予抗     

亚急性型外源性过敏性肺泡炎一例

患者,女性,62岁。因进行性胸闷、喘憋1个月,于2004年9月10日收入院。入院前1个月余因感冒后出现喘息、憋气,活动后加重,以夜间为著,伴有少量咳嗽、咳白痰。追问病史,其爱人于家中饲养多种鸟(鸽子、百舌、聊鸽、鹦鹉)达40余年,近6个月来因搬家后与家庭饲养的鸟类同处一室。     

外源性过敏性肺泡炎3例临床分析及治疗

目的探讨外源性过敏性肺泡炎的临床特点、诊断和治疗。方法总结外源性过敏性肺泡炎3例,对其临床表现、影像学特点、诊断及治疗方法进行分析。结果外源性过敏性肺泡炎有特殊环境暴露史,主要症状为咳嗽、活动后气短等。肺部症状无特异性,有较为典型的CT表现,确诊需依靠纤维支气管镜检查,支气管肺泡灌洗及肺活检。结论支气管肺泡灌洗液检查及肺活检有利于外源性过敏性肺泡炎的诊断。避免接触过敏原是治疗的关键,糖皮质激素疗效明显。     

外源性过敏性肺泡炎8例分析

我们从某造纸厂谷草粉碎车间发现外源性过敏性肺泡炎(EAA)8例,本文结合该8例患者的临床特征着重讨论EAA的诊断和鉴别诊断.     

外源性过敏性肺泡炎2例临床分析

一、病例摘要病例1患者,男性,52岁,因"咳嗽、气促1天"于2011年5月22日收治我院呼吸内科,患者病程中有发热,体温最高39℃,右侧胸痛,有咯血,色鲜红,量约100 ml左右。胸片示右肺炎(图1a)。患者既往体健。入院查体:体温38.2℃,脉搏108次/分,呼吸频率32次/分,血压75/44 mmHg,神志清,气促明显,对答困难,口唇轻度紫绀,双肺呼吸音粗,可及明显     

外源性过敏性肺泡炎1例报告

外源性过敏性肺泡炎（extrinsic allergic alveolitis,EAA）,也称为过敏性肺炎（Hypersensitivity pneumonitis,HP）,是易感者反复吸入多种具有抗原性的有机粉尘及低分子化学物质所引起的一组临床综合征。病变主要累及两肺远端的细支气管、肺泡及肺间质,临床少见,但近年来发病率有上升趋势。     

过敏性肺泡炎发病机理研究进展

本文综述近年来过敏性肺泡炎发病机理的研究进展,重点介绍本病动物模型、BAL 细胞分析、细胞介素及免疫遗传等资料.     

蘑菇过敏性肺泡炎12例临床分析

外源性过敏性肺泡炎是一组由于吸入具有抗原性的有机粉尘所引起的肺泡壁变态反应性炎症性疾患 ,常同时累及细支气管。吸入的抗原物质虽然不同 ,但都具有共同的免疫致病机理、组织病理学改变及临床表现。蘑菇肺属于本病的一种。临床资料1 .一般资料 :1 2例患者中 ,男性 5例 ,女性 7例 ,年龄 1 4～56岁 ,平均年龄 32岁。所有患者均系种蘑菇农民。种植蘑菇至发病时间 8ｈ～ 1年不等。2 .临床表现 :以气短为首发症状 8例 ,干咳 9例 ,咯痰 5例 ,发热 8例 ,乏力 1 0例 ,消瘦 9例。全部患者均有不同程度的胸闷和呼吸困难。体格检查 :口唇发绀 4例 ,…     

外源性过敏性肺泡炎14例临床分析

目的探讨外源性过敏性肺泡炎的临床特征及防治手段。方法分析湖北省宜都市第一人民医院呼吸内科2003年收治的14例外源性过敏性肺泡炎患者的临床表现、影像学及流行病学特点。结果14例患者发病前均有职业环境接触史,发热、咳嗽、咳痰、呼吸困难、肺部干性及湿性啰音是主要的症状和体征?喂δ芟允鞠拗?性通气功能障碍4例(28.6%)。血气分析显示低氧血症4例(28.6%)。肺部CT表现为双中下肺野改变12例(85.7%),其中9例(64.3%)双肺见斑片状磨玻璃影,1例(7.1%)伴有局限性的肺气肿,2例(14.3%)左上肺野出现网格状条索影。14例患者支气管肺泡灌洗液中淋巴细胞占细胞总数的比例增高(>20%),CD4/CD8平均值为0.64±0.21,IgM、IgG阳性13例(92.9%)。10例患者给予糖皮质激素治疗,4例患者给予抗感染治疗,30～40d后复查CT显示12例(85.7%)患者肺部阴影完全消失,2例(14.3%)患者肺部阴影部分吸收。结论外源性过敏性肺泡炎的临床特征、影像学改变、肺功能及免疫学检查无特异性,支气管肺泡灌洗液检查对其诊断有较高的价值。避免接触过敏原是治疗的关键,糖皮质激素疗效明显。     

过敏性肺泡炎16例的临床

20 0 0年至 2 0 0 2年收治过敏性肺泡炎 (HP)患者 16例 ,结合实验室检查 ,回顾性分析如下。临床资料1.一般资料16例患者中男 6例 ,女 10例 ;年龄 15～ 5 0岁 ;病程两周至两个月。接触鸽子者 10例 ,接触鹦鹉者 2例 ,接触染发剂者 1例 ,原因不明确者 3例。 16例均有咳嗽、咯痰及气短病史。其中4例发热 ,体温 37.5℃ - 38.2℃。双肺闻及 velcro罗音 2例 ,闻及捻发音者 2例 ,呼吸音粗糙者 3例 ,双肺 10例听诊正常。口唇发绀者 6例 ,有肺动脉第二音亢进者 2例 ,杵状指者 1例。2 .辅助检查(1)血气分析 :16例患者 p H值 7.4 0 6～ 7.4 5 9,Pa O2 …     

Physiopathology of extrinsic allergic alveolitis]

The extrinsic allergic alveolites classically represent the immunological reaction of type III of the lower respiratory tract. In fact, all immunological mechanisms and several non specific factors are involved in these affections. If delayed hypersensitivity (type I) is today considered as part of the disease, the mechanisms involving reagins (type I) are also probably part of it but it is not so evident for type II reactions. Non specific factors are numerous, often hypothetical, because they are still experimental and not all enumerated. The activation of alveolar macrophages, the triggering of the complement system by another way, the enzymes found in dust or the irritation produced by inhaled products are all important factors.     

Bronchoalveolar lavage in extrinsic allergic alveolitis

The precise immunopathological mechanism of extrinsic allergic alveolitis explaining the clinical picture as well as the pathological findings is not known. Bronchoalveolar lavage can be a diagnostic help and a method to unravel the pathophysiology of this disease. In the acute stage of extrinsic allergic alveolitis or within 24 h after antigen exposure an increase in the number of neutrophils is seen. After the acute stage, the number of lymphocytes is even higher than in sarcoidosis. In extrinsic allergic alveolitis as well as in sarcoidosis these lymphocytes are mainly T lymphocytes. However, the distribution of OKT 4 and OKT 8 positive lymphocytes was clearly different in both diseases. In sarcoidosis OKT 4 lymphocytes predominate (OKT 4/8 = 7.8) while in extrinsic allergic alveolitis an increase of both OKT 4 and OKT 8 lymphocytes has been found (OKT 4/8 = 1.5). Whether a type III Arthus reaction or a type IV delayed hypersensitivity with an early component is involved, is discussed.     

The HRCT features of extrinsic allergic alveolitis

Exposure to organic dusts can produce an immune-mediated inflammatory response in sensitized individuals. The pulmonary disease caused by this response has been called extrinsic allergic alveolitis (EAA) or hypersensitivity pneumonitis. The clinical phases associated with this process have been termed acute, subacute, and chronic. There are corresponding imaging findings that are characteristic of each of these phases, although there is some overlap between the phases. The acute phase is characterized by confluent opacities that may mimic infection or edema. The subacute phase is characterized by centrilobular nodules, areas of ground-glass attenuation, a mosaic perfusion pattern, and air trapping on expiratory imaging. The chronic phase is characterized by subpleural irregular linear opacities with associated architectural distortion. Honeycombing may sometimes also be present. In the acute and subacute phases, the disease is predominantly in the lower lungs, whereas in chronic EAA the findings are predominant in the mid to upper lungs. Although the high-resolution computed tomography findings individually are nonspecific, the combination of the findings coupled with the distribution of the findings can often narrow the differential or allow a presumptive diagnosis of EAA to be made.     

外源性过敏性肺泡炎二例报告并文献复习

报道２例外源性过敏性肺泡炎，结合文献对其致敏因子、症状、胸片特征、病理改变加以分析，本病去除致病原并经激素治疗可获得良好效果。慢性期将导致不可逆的肺间质纤维化。     

Cockade-like structures in alveolar macrophages in extrinsic allergic alveolitis

BACKGROUND AND OBJECTIVES: In immunocytochemical preparations of bronchoalveolar lavage (BAL) cells from patients with extrinsic allergic alveolitis (EAA), we observed the presence of alveolar macrophages with cockade-like structures in their cytoplasm (cockade+ alveolar macrophages). These cockade+ alveolar macrophages may reflect a subpopulation of alveolar macrophages which may show a different predominance in various interstitial lung diseases. In this study we aimed to compare the frequency of cockade+ alveolar macrophages in patients with EAA (n = 14) with the results obtained in patients with sarcoidosis (n = 11), idiopathic interstitial pneumonia (IIP; n = 10) and control subjects (n = 8). We also investigated the expression of the transferrin receptor CD71 on cockade+ alveolar macrophages. METHODS: In BAL fluid, the total number of cells and differential counts were determined, and immunocytologic examinations of macrophages and lymphocytes were done using monoclonal antibodies. The percentage of cockade+ alveolar macrophages was determined by counting 300 macrophages in the CD20 field of an immunocytochemical slide. RESULTS: The percentage of cockade+ alveolar macrophages was significantly higher in the EAA group (36 +/- 9%) compared to patients with sarcoidosis (12 +/- 5%) or IIP (11 +/- 10%) and control subjects (3 +/- 1%; p < 0.001). The proportion of CD71+ alveolar macrophages was significantly lower in EAA than in the other groups (p < 0.01), and the CD71 antigen was expressed on a significantly lower proportion of cockade+ alveolar macrophages compared to cockade- alveolar macrophages in EAA (p < 0.001). CONCLUSION: We conclude that cockade+ alveolar macrophages could play a role in the pathogenesis and differential diagnosis EAA.     

Provocation tests in extrinsic allergic alveolitis in mushroom workers

The clinical diagnosis of extrinsic allergic alveolitis can be supported by a positive provocation test. Twenty-eight common mushroom (Agaricus bisporus) workers, 4 oyster mushroom (Pleurotus ostreatus) workers and 6 Shii Take mushroom (Lentinus edodes) workers, whose medical history indicated a possible extrinsic allergic alveolitis, were examined. The provocation test consisted of a control day, an exposure day, and half a day of follow-up observation. On the control and exposure days, the body temperature, leucocyte count and lung function were measured every 2 h. The chest X-ray and arterial blood gas sample were taken once. The exposure consisted of a 1-h presence on the common mushroom farm in spawning conditions or inhaling a suspension of spores of Pleurotus or Shii-Take in the laboratory. Eighteen of the 28 people employed on the common mushroom farm, all 4 Pleurotus workers and 4 of the 6 Shii-Take workers were diagnosed as having extrinsic allergic alveolitis, according to the following criteria: a positive history and 2 or more of the following findings: increase in leucocyte count, rise in temperature and decrease in inspiratory vital capacity (IVC) and total lung capacity (TLC).