芒果视频

嗜(shi)酸(suan)(suan)(suan)性(xing)細(xi)胞(bao)性(xing)肺(fei)炎(yan)是一組(zu)病因明確或尚未明確，以嗜(shi)酸(suan)(suan)(suan)性(xing)細(xi)胞(bao)浸(jin)潤為(wei)特(te)點(dian)，常伴周圍血嗜(shi)酸(suan)(suan)(suan)細(xi)胞(bao)增多(duo)的疾(ji)病。有(you)時稱(cheng)為(wei)嗜(shi)酸(suan)(suan)(suan)性(xing)細(xi)胞(bao)增多(duo)性(xing)肺(fei)浸(jin)潤(PIE)綜合征。

基本概述

嗜酸(suan)性細(xi)胞性肺炎是一組病(bing)因明確(que)或尚(shang)未明確(que)，以嗜酸(suan)性細(xi)胞浸潤為特點，常伴周圍血嗜酸(suan)細(xi)胞增多的疾(ji)病(bing).

有時(shi)稱為嗜酸性(xing)細胞增多性(xing)肺(fei)浸潤（PIE）綜合(he)征。

病因學和發病機制

病(bing)(bing)因包括(kuo)寄生(sheng)蟲（如(ru)蛔蟲，弓(gong)蛔蚴蟲和絲蟲），藥(yao)物(wu)（如(ru)青霉(mei)(mei)(mei)素(su)，對(dui)氨基(ji)水楊酸，肼苯噠嗪(qin)，呋喃妥因，氯丙嗪(qin)，磺胺制劑）；化(hua)學過(guo)敏(min)物(wu)質（如(ru)蒸(zheng)氣形式吸入的碳化(hua)鎳）；和真菌（如(ru)煙曲霉(mei)(mei)(mei)，它引起(qi)變應性(xing)支氣管肺曲霉(mei)(mei)(mei)病(bing)(bing)見后述）.盡管疑有過(guo)敏(min)性(xing)機制，但大多(duo)數嗜酸性(xing)細(xi)胞肺炎(yan)病(bing)(bing)因不明(ming).嗜酸性(xing)細(xi)胞增多(duo)提示為第(di)Ⅰ型過(guo)敏(min)反應，綜合征的其他特點（血(xue)管炎(yan)，圓細(xi)胞浸(jin)潤）提示為第(di)Ⅲ型亦可能為第(di)Ⅳ型反應.

嗜酸性(xing)細(xi)(xi)胞(bao)性(xing)肺(fei)炎(yan)（表76-3）常(chang)合(he)并有支(zhi)氣(qi)管哮喘.合(he)并哮喘及病因不明的嗜酸性(xing)細(xi)(xi)胞(bao)性(xing)肺(fei)炎(yan)可分為三類(lei)：外源性(xing)支(zhi)氣(qi)管哮喘伴(ban)PIE綜(zong)(zong)合(he)征(zheng)，事實(shi)上(shang)，常(chang)為變應(ying)性(xing)支(zhi)氣(qi)管肺(fei)曲霉病；內源性(xing)支(zhi)氣(qi)管哮喘伴(ban)PIE綜(zong)(zong)合(he)征(zheng)（慢性(xing)嗜酸性(xing)細(xi)(xi)胞(bao)性(xing)肺(fei)炎(yan)），胸片上(shang)常(chang)出現特征(zheng)性(xing)的肺(fei)周圍部浸潤；和變應(ying)性(xing)肉芽腫病（Churg-Strauss綜(zong)(zong)合(he)征(zheng)，一種(zhong)結節(jie)性(xing)多關(guan)節(jie)炎(yan)伴(ban)肺(fei)病變）.單純性(xing)嗜酸性(xing)細(xi)(xi)胞(bao)性(xing)肺(fei)炎(yan)（LÖffler綜(zong)(zong)合(he)征(zheng)）偶可合(he)并哮喘.

不伴(ban)哮喘的(de)(de)嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)肺(fei)(fei)炎(yan)包括急(ji)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)肺(fei)(fei)炎(yan)，嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)肌痛(tong)(tong)綜合(he)征和(he)(he)嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)增(zeng)多(duo)綜合(he)征.急(ji)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)肺(fei)(fei)炎(yan)是一種原因不明的(de)(de)不同病種，可引起急(ji)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)發熱，嚴(yan)重(zhong)低氧血(xue)癥，彌(mi)漫性(xing)(xing)(xing)(xing)(xing)(xing)(xing)肺(fei)(fei)浸(jin)潤(run)(run)以及(ji)支氣管肺(fei)(fei)泡灌洗液中的(de)(de)嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)比例>25%.經皮質激素治療可迅速，徹底緩解.嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)肌痛(tong)(tong)綜合(he)征與食(shi)(shi)用(yong)大量的(de)(de)作為(wei)食(shi)(shi)物添加(jia)劑的(de)(de)L-色氨酸(suan)(suan)有(you)關.肺(fei)(fei)浸(jin)潤(run)(run)偶(ou)可伴(ban)有(you)肌痛(tong)(tong)，肌無力(li)，皮疹和(he)(he)類(lei)似于硬皮病的(de)(de)軟組織硬結.嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)增(zeng)多(duo)綜合(he)征的(de)(de)診斷標準為(wei)持續性(xing)(xing)(xing)(xing)(xing)(xing)(xing)嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)增(zeng)多(duo)（>1500/mm3）達6個月以上，缺乏其他引起嗜(shi)(shi)酸(suan)(suan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)細(xi)(xi)(xi)胞(bao)增(zeng)多(duo)的(de)(de)病因，累(lei)及(ji)心，肝，脾，中樞(shu)神經系統(tong)或肺(fei)(fei)，心臟最常受(shou)累(lei).發熱，體(ti)重(zhong)減輕和(he)(he)貧(pin)血(xue)也常見,常可發生動脈而(er)非(fei)靜脈性(xing)(xing)(xing)(xing)(xing)(xing)(xing)血(xue)栓栓塞疾病。

特征性改變包(bao)括嗜(shi)酸性細(xi)胞(bao)(bao)，大(da)單(dan)核(he)(he)細(xi)胞(bao)(bao)充(chong)滿肺泡，肺泡間隔內(nei)(nei)嗜(shi)酸性細(xi)胞(bao)(bao)，漿細(xi)胞(bao)(bao)和大(da)，小單(dan)核(he)(he)細(xi)胞(bao)(bao)浸潤.也可有細(xi)支氣(qi)管內(nei)(nei)粘(zhan)液填塞和血管浸潤。

癥狀和體征

癥(zheng)狀和(he)體征(zheng)可輕(qing)微，也可危及生(sheng)命.可伴低(di)度(du)發(fa)熱，輕(qing)度(du)（如有）呼(hu)吸(xi)道癥(zheng)狀，可即時恢(hui)復.其(qi)他類(lei)(lei)型(xing)的PIE綜合征(zheng)，可有發(fa)熱和(he)支氣管哮(xiao)喘癥(zheng)狀，包括咳(ke)嗽，喘鳴和(he)靜(jing)息時呼(hu)吸(xi)困(kun)難.如不(bu)治療(liao)，慢性(xing)嗜(shi)(shi)酸性(xing)細胞性(xing)肺炎常(chang)進行性(xing)發(fa)展至危及生(sheng)命，類(lei)(lei)似急性(xing)嗜(shi)(shi)酸性(xing)肺炎.常(chang)有明(ming)顯(xian)增高的嗜(shi)(shi)酸性(xing)細胞（20%~40%，有時更高）.胸部(bu)X線表現(xian)為不(bu)同肺葉內有迅速(su)出現(xian)及迅速(su)消失的浸(jin)潤病(bing)灶（游走性(xing)浸(jin)潤）。

臨床診斷

根據病(bing)(bing)(bing)人(ren)居住(zhu)的地(di)理區域尋找(zhao)致病(bing)(bing)(bing)蠕(ru)蟲，痰內可找(zhao)到(dao)寄生(sheng)蟲和(he)煙(yan)曲霉，需仔細詢問用藥史.鑒別診(zhen)斷包括結核，結節(jie)病(bing)(bing)(bing)，霍奇金病(bing)(bing)(bing)和(he)其他淋巴組(zu)織增(zeng)生(sheng)性(xing)(xing)疾(ji)(ji)病(bing)(bing)(bing)，肺嗜(shi)酸性(xing)(xing)細胞性(xing)(xing)肉芽(ya)(ya)腫，脫屑性(xing)(xing)間質性(xing)(xing)肺炎和(he)膠原性(xing)(xing)血(xue)管疾(ji)(ji)病(bing)(bing)(bing)。過敏性(xing)(xing)肺炎和(he)Wegener肉芽(ya)(ya)腫常不伴嗜(shi)酸性(xing)(xing)細胞增(zeng)多。

治療

本病可為自限性(xing)，呈良性(xing)，可不需治(zhi)(zhi)療.如癥狀(zhuang)嚴重，使(shi)用(yong)皮質類(lei)固醇(chun)常有極(ji)好效果；對(dui)于急性(xing)嗜酸性(xing)細胞肺炎(yan)和特發(fa)性(xing)慢性(xing)嗜酸性(xing)肺炎(yan)者該(gai)治(zhi)(zhi)療可挽救(jiu)生命。如出(chu)現支(zhi)氣管哮(xiao)喘(chuan)，采用(yong)通常治(zhi)(zhi)療方(fang)法.有蠕(ru)蟲感染的，應使(shi)用(yong)驅蟲藥(yao)。