外源性过敏性肺泡炎21例病理和临床分析

目的 探讨外源性过敏性肺炎(extrinsic allergic alveolitis, EAA)的临床病理特点,提高临床和病理的诊断水平。方法回顾性分析经肺活检病理诊断的21例EAA的临床、影像和病理特点并进行随访。结果 21例中女14例、男7例,年龄范围24～79岁(中位年龄51岁)。14例(66.7%)有过敏原接触史,其中7例为有机和无机物,5例有养猫、狗和鸽子史,2例有羊毛和皮革化纤接触史,4例(19.0%)无明显过敏原接触史,3例(14.3%)不详。主要症状是间断性咳嗽、咳痰、气喘。胸部CT均显示双肺弥漫性或者片状磨玻璃影。13例经电视胸腔镜(VATS)/小切口开胸肺活检、8例经TBLB肺活检,病理形态学表现为细支气管炎、间质淋巴细胞浸润、上皮样细胞或者多核巨细胞聚集(14例,66.7%)、非干酪性上皮样肉芽肿形成(8例,38.1%)。9例(42.9%)分别误诊为细菌性肺炎、肺结核和真菌感染。脱离过敏原和糖皮质激素治疗效果好。结论EAA的临床和影像表现缺乏特征性,宠物以及其他过敏原接触史对诊断有重要的提示作用；病理组织学上部分患者缺乏特征性的上皮样结节形成,病理诊断需要结合临床和胸部影像学的表现。

Clinicopathological features of extrinsic allergic alveolitis:an analysis of 21 cases

Objective To analyze the clinicopathologic features of extrinsic allergic alveolitis (EAA). Methods The clinical, radiologic and pathological data of 21 patients with biopsy-diagnosed EAA were retrospectively reviewed. Results In 21 cases 14 were females and 7 were males, aged 24-79 years (median 51y). Fourteen cases(66.7%)had allergic history, including 7 cases exposed to organic and inorganic allergens, 5 exposed to domestic cats, dogs and pigeons, 2 exposed to wool and synthetic leather. Among remaining 7 cases, 4 cases(19.0%)had no allergic history, 3 cases(14.3%)were unknown. The clinical manifestations mainly included intermittently cough,production of sputum and asthma. Chest CT showed bilateral pulmonary diffuse or patchy ground glass opacities. The lung samples were taken by video-assisted thoracoscope/small incision thoracotomy lung biopsy in 13 cases and by transbronchil lung biopsy (TBLB) in 8 cases. The pathological morphology presented with bronchiolitis, interstitial infiltration of lymphocytes, epithelioid cells or multinucleated giant cell aggregation (14 cases, 66.7%), non-caseous granuloma formation (8 cases, 38.1%).Nine cases were misdiagnosed as bacterial pneumonia, tuberculosis and fungal infection. The patients had a favorable outcomes with glucocorticoid therapy and avoiding allergens. Conclusion The clinical manifestations and imaging characteristics of EAA are unspecific, diagnosis requires the integration of exposure history, clinical, radiographic and pathological findings.