摘要
目的分析、总结弥漫性肺浸润(diffuse pulmonary infiltrates,DPI)的病因构成、临床特点、胸部影像学特点、鉴别诊断要点、实验室检查要点,以提高临床医师对DPI的认识和诊治水平。方法前瞻性研究我院2010年3月至2011年7月诊治的82例DPI患者的临床资料,包括病史、体征、影像学、实验室检查等资料,并进行分析总结。结果 82例DPI患者的病因构成如下:感染性疾病30例(36.6%),特发性间质性肺炎(idiopathic interstitial pneumonia,IIP)17例(20.7%),结缔组织疾病(connective tissue disease,CTD)肺部浸润9例(11%),肺癌6例(7.3%),血管炎4例(4.9%),肺水肿4例(4.9%),结节病3例(3.7%),肺泡蛋白沉着症2例(2.4%),淋巴瘤、肺泡微石症、放射性肺炎、吸入性肺炎、药物因素致肺纤维化、弥漫性泛细支气管炎、特发性肺含铁血黄素沉着症各1例(1.2%)。不同病因的DPI在临床病史、体征、胸部影像学、实验室检查及肺活检病理学检查等方面都有各自的特点。结论 DPI病因复杂,以感染性疾病及IIP、CTD较常见,发热、Velcro啰音等是重要的有鉴别诊断价值的临床特点,磨玻璃影、网格影、结节影等是特征性的有鉴别诊断价值的影像学表现,感染性疾病应注重病原学检查,非感染性疾病应注重一些特殊实验室检查及病理学检查。
Objective To study and summarize the cause,clinical feature,chest imaging feature,key points of differential diagnosis and laboratory examination of diffuse pulmonary infiltrates（DPI）,so as to improve clinicians＇ understanding and levels of diagnosis and treatment of DPI.Methods Clinical data of 82 patients who were diagnosed as DPI in our hospital from Mar 2010 to Jul 2011 were prospectively analyzed,including medical history,signs,chest imaging,laboratory examination and lung biopsy pathological examination.Results The causes of 82 DPI patients included infectious disease（30/82,36.6%）,idiopathic interstitial pneumonia（IIP）（17/82,20.7%）,connective tissue disease（CTD） pulmonary infiltrates（9/82,11%）,lung cancer（6/82,7.3%）,vasculitis（4/82,4.9%）,pulmonary edema（4/82,4.9%）,sarcoidosis（3/82,3.7%）,pulmonary alveolar proteinosis（2/82,2.4%）,lymphoma（1/82,1.2%）,alveolar microlithiasis（1/82,1.2%）,radiation pneumonitis（1/82,1.2%）,aspiration pneumonia（1/82,1.2%）,drug-induced pulmonary fibrosis（1/82,1.2%）,diffuse panbronchiolitis（1/82,1.2%） and idiopathic pulmonary hemosiderosis syndrome（1/82,1.2%）.Patients with different causes of DPI had their own characteristics in clinical history,signs,chest imaging,laboratory tests and lung biopsy pathology etc.Conclusion Causes of DPI were complicated,and infectious diseases,IIP and CTD were the common causes.Fever and velcro rales were important clinical features,and ground glass,grid shadow and nodules were imaging characteristics for differential diagnosis.Infectious diseases should focus on etiology examination,while non-infectious diseases should focus on special laboratory and pathological examinations.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2012年第3期257-260,共4页
Journal of Third Military Medical University
基金
重庆市卫生局重点项目(2008-1-01)~~
关键词
弥漫性肺浸润
临床
影像学
病因
鉴别诊断
diffuse pulmonary infiltrate
clinical
imaging
cause
differential diagnosis
