摘要
目的探讨特发性肺纤维化(IPF)急性加重患者的临床和胸部影像学特点,提高对IPF急性加重的认识。方法回顾性分析2006年4月至2008年7月南京鼓楼医院呼吸科收治的2例IPF急性加重患者的临床和影像学资料,并复习相关文献。结果2例患者均为老年男性,主要的症状和体征为气短、咳嗽及吸气性爆裂音。呼吸困难分别在1周和半月内加重;2例患者氧合指数均小于225mmHg;急性加重时2例患者HRCT表现为两下肺分布的网状影、蜂窝影、牵拉性细支气管扩张和支气管扩张等典型的IPF表现,并出现新的磨玻璃影。其中1例患者的双肺新出现的磨玻璃影,沿胸膜下蜂窝肺外周分布;另1例患者HRCT表现为新出现的磨玻璃影呈弥漫性分布。2例患者均接受激素治疗。1例患者气紧、咳嗽症状明显缓解,胸部HRCT的磨玻璃样影基本吸收;另1例患者死于呼吸衰竭。结论少数IPF患者可在无诱因下出现急性加重。IPF急性加重患者主要临床表现为呼吸困难症状在短期内急剧恶化,其胸部影像学特点为在典型的IPF表现基础上出现新的磨玻璃影。
Objective To analyze the clinical presentations and radiological characteristics of acute exacerbation of idiopathic pulmonary fibrosis （IPF）. Methods Clinical and radiological data of 2 patients with acute exacerbation of IPF from April 2006 to July 2008 were retrospectively analyzed and literatures were reviewed. Results Both patients were senior male patients over 60 years old. Dyspnea, cough and inspiratory crackles were the major symptoms and signs. Two patients were experiencing an exacerbation of dyspnea for one week and half of month, respectively. PaO2/FiO2 of both patients was less than 225 mm Hg. In both patients, high-resolution computed tomography （ HRCT ） scans at the exacerbation showed typical signs of IPF including peripheral predominant, basal predominant reticular abnormality, with honeycombing and traction bronchiectasis and bronchiolectasis, and newly developing alveolar opacity. HRCT scan showed peripheral area of ground-glass attenuation adjacent to subpleural honeycombing in one patient, and diffusely distributed ground-glass opacity in another patient. Two patients had received corticosteroid treatment. For one patient, the symptoms improved, and ground-glass attenuation adjacent to subpleural honeycombing had almostly resolved. The other patient died of respiratory failure. Conclusions Some acute exacerbation in idiopatic pulmonary fibrosis can be idiopathic. The clinical presentations mainly include the worsening of dyspnea within short time. HRCT generally demonstrates new bilateral ground-glass abnormality with or without areas of consolidation, superimposed on typical changes of IPF.
出处
《中国呼吸与危重监护杂志》
CAS
2009年第4期355-359,共5页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
特发性肺纤维化
急性加重
症状
体征
影像诊断
高分辨率CT
Idiopathic pulmonary fibrosis
Acute exacerbation
Symptoms
Signs
Diagnostic imaging
High-resolution computed tomography
