小血管炎的肺脏表现--6例报告并文献复习

目的　从肺脏损害角度探讨小血管炎的肺部表现 ,以指导临床上正确的诊断和治疗。方法　采用回顾性方法对确诊的 6例小血管炎患者临床资料进行分析。结果　小血管炎临床表现复杂多样 ,6例患者均有多系统受损的表现 ,主要累及肾脏、皮肤、神经肌肉系统、眼、耳及肺脏。均有咳嗽、咯痰及呼吸困难等症状 ,其中 2例出现痰中带血 ,1例并发急性呼吸衰竭。胸部X线片检查 :2例出现肺部浸润影 ,多个肺野分布 ,且具有反复出现和形态多变的特点 ;1例表现为双肺广泛磨玻璃样肺间质性改变。 2例为典型的慢性阻塞性肺疾病的X线表现 ,肺功能检查也符合其特征。3例有明显桶状胸 ,3例肺部可闻及广泛湿音。结论　小血管炎的临床表现极为复杂 ,累及肺脏时极易误诊为其他肺疾病 ;正确的诊断思路以及提高对该病的认识有助于减少误诊 ;早期皮质激素和免疫抑制剂的应用能显著改善患者的预后

Pulmonary manifestations of small vasculitis--six cases report and literature review

Objective To investigate the respiratory manifestations of small vasculitis with lung involvement in order to improve diagnosis and treatment.Methods Clinical data of six diagnosed cases of small vasculitis were analyzed retrospectively.Results All six cases were reported of multiple systemic damages,mainly involving kidney, skin, neuromuscular system, eyes, ears and lung.All of the patients experienced cough,sputum,and dyspnea with hemoptsis in two cases, and acute respiratory failure in one case.Chest radiographs showed variable and multiform pulmonary infiltrations in multiple lung fields in 2 cases,extensive interstitial ground-like opacities on bilateral lung field in one case,and features of COPD in 2 cases, whose lung function was also suggestive of COPD. On physical examination,apparent barrel chest was revealed in three cases and diffuse rales were ausculated on the basis of lung in three cases.Conclusions Pulmonary lesion caused by small vasculitis characterized by is predisposed to be misdiagnosed as other lung diseases. Awareness and comprehensive knowledge of disease spectrum are critical to avoid misdiagnosis.Early administration of corticosteroids and immune suppressors may significantly improve the prognosis of the patients.