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.

Chronic eosinophilic pneumonia: report of one case and review of liferature

Objective To raise awareness of chronic eosinophilic pneumonia (CEP) by introducing one case of CEP and reviewing nine domestic literature reports (ten patients) in the past 7 years. Methods The clinical and follow-up data of one patient with CEP were analyzed, and clinical features, diagnosis and treatment of CEP were discussed combining with literatures. Results CEP is a chronic eosinophil inflammation of lung with unknown cause. The features of CEP were that the patients had history of hypersensitivity disease, most patients had expectoration, fever, different degrees of dyspnoea, and clinical manifestations of some patients were negative, but found in the examination. Peripheral blood eosinophils and erythrocyte sedimentation rate in most patients significantly increased. Chest X-ray film showed nonlung segment distribution, progressivity, and high-density infiltrations in the pulmonary peripheral.Reverse pulmonary edema sign was often found. Eosinophils significantly increased in sputum and (or)bronchoalveolar lavage fluid. Anti-infective therapy was ineffective but oral corticosteroid therapy had good response. The shadow rapidly absorbed after oral corticosteroid therapy, the overall prognosis was good. Conclusions For pneumonia patients with aforesaid features and ineffective antibiotic treatment,CEP should be suspected,eosinophil counts by bronchoalveolar lavage or percutaneous lung biopsy in time can make a definite diagnosis.