摘要
[背景]矽肺与机化性肺炎合并发生罕见报道,临床医生对其认识不足,经常导致漏诊及误诊。[目的]探讨矽肺合并机化性肺炎的临床、影像及病理特点。[方法 ]回顾性分析2012年3月至2018年1月间经福建医科大学附属泉州第一医院确诊的119例矽肺合并机化性肺炎患者的临床资料,对其临床表现、实验室检查、影像学检查、病理学检查、治疗及预后进行综合分析。[结果 ] 119例患者中,男性116例,女性3例;平均年龄(48.7±8.8)岁。患者均为石材加工工人,平均粉尘接触史为(30.0±7.1)年。最常见的症状分别为咳嗽(95.8%)、咳痰(87.4%)、发热(71.4%)、气喘(66.4%),最常见的体征为湿性啰音(60.5%)。实验室检查结果为血沉加快[(66.6±26.6)mm/h]、血C-反应蛋白升高[(110.8±73.0)mg/L]、血神经元特异性烯醇化酶升高(中位数为28.19μg/L)、氧合状况差(氧合指数中位数为214 mmHg)。全部患者均可见典型的矽肺影像学表现。此外,CT表现为多发片状、斑片状渗出实变影,以双侧性及下叶分布为主,并沿支气管分布。病理活检的阳性率为78.4%。病理学表现为细支气管间隔增宽并纤维化,细支气管及肺泡腔内见成纤维细胞增生性栓子,栓子内可见粉尘沉积,Masson染色示机化结缔组织呈蓝色。119例患者均给予全身糖皮质激素治疗,治疗后1个月进行疗效评价:98例患者病情明显好转,占82.3%;19例患者部分好转,占16.0%;2例患者病情进行性加重、死亡,占1.7%。经4~74个月(中位数为14个月)随访,35例患者总共出现85例次复发,复发患者再次给予糖皮质激素治疗仍然有效。[结论 ]矽肺合并机化性肺炎缺乏特异性表现,易误诊为肺部感染性疾病,确诊需综合临床、影像、病理进行分析。糖皮质激素治疗对其疗效好,但易复发。
[Background]The incidences of silicosis co-occurring with organizing pneumonia are rarely reported and often misdiagnosed due to insufficient understanding by clinicians.[Objective]This article aims to explore the clinical,radiological,and pathological features of silicosis complicated with organizing pneumonia.[Methods]The clinical manifestations,laboratory tests,radiological images,pathological features,treatment,and prognosis were retrospectively analyzed in 119 silicosis with organizing pneumonia cases from March 2012 to January 2018 in First Hospital of Quanzhou Affiliated to Fujian Medical University.[Results]There were 119 patients including 116 males and 3 females with a mean age of(48.7±8.8)years.All patients were stonecutters with a mean occupational silicon dioxide particles exposure history of(30.0±7.1)years.The main clinical manifestations were cough(95.8%),sputum production(87.4%),fever(71.4%),dyspnea(66.4%),and moist rales(60.5%).The results of laboratory tests showed elevation of erythrocyte sedimentation rate[(66.6±26.6)mm/h],serum level of C-reactive protein[(110.8±73.0)mg/L],and neuron-specific enolase(median,28.19μg/L),as well as moderate or severe hypoxemia(median oxygenation index,214 mmHg).All patients showed typical radiological images of silicosis.The results of CT scans showed multiple patchy alveolar opacities,usually bilateral and in lower lobe,with bronchial distribution.The positive rate of lung biopsy was 78.4%.Histologically,widened bronchial septa and pulmonary interstitial fibrosis were noted in all patients;polypoid growth of granulation tissues with silicon dioxide particles deposition were presented within small airways and alveolar spaces;with Masson staining,organizing fibers were found blue.All patients received glucocorticoid therapy,and the therapeutic effects were evaluated 1 month after the treatment:98 patients(82.3%)achieved a complete response,19 patients(16.0%)achieved a partial response,and 2 patients(1.7%)died of progressive aggravation.Moreover,35 patients e
作者
黄鸿波
庄锡彬
郑锦阳
戴凯峰
林艺坚
尤玲燕
寇美丽
许小婷
HUANG Hong-bo;ZHUANG Xi-bin;ZHENG Jin-yang;DAI Kai-feng;LIN Yi-jian;YOU Ling-yan;KOU Mei-li;XU Xiao-ting(Department of Respiratory Medicine,First Hospital of Quanzhou Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China;Pathology Department,First Hospital of Quanzhou Affiliated to Fujian Medical University,Quanzhou,Fujian362000,China;Radiology Department,First Hospital of Quanzhou Affiliated to Fujian Medical University,Quanzhou,Fujian362000,China)
出处
《环境与职业医学》
CAS
CSCD
北大核心
2019年第8期761-766,共6页
Journal of Environmental and Occupational Medicine
基金
泉州市科技局(2018N053S)
关键词
矽肺
机化性肺炎
职业暴露
糖皮质激素
预后
silicosis
organizing pneumonia
occupational exposure
glucocorticoid
prognosis
