摘要
目的提高对巨细胞间质性肺炎(GIP)的临床表现、胸部影像学和病理组织学的认识。方法对2例经病理证实的GIP患者的职业史、临床表现、胸部X线、CT和病理资料,结合有关文献进行回顾性分析。结果 GIP属于硬金属尘肺,主要临床表现有咳嗽和活动后呼吸困难。肺功能检查表现为限制性通气功能障碍。胸部X线和HRCT表现为两肺磨玻璃样影、实变影、弥漫性的小结节影、网状影和牵拉性支气管扩张。GIP主要病理改变为脱屑性间质性肺炎样反应,即在肺泡腔内有巨噬细胞和大量的多核巨细胞聚集;位于肺泡腔内的多核巨细胞内可见被吞噬的炎性细胞,为GIP的特征性改变。结论 GIP是非常罕见的慢性间质性肺炎,无特异性的临床表现,影像学表现类似于特发性间质性肺炎。仔细收集患者的职业史有助于减少误诊和漏诊。
Objective To highlight the characteristics of giant cell interstitial pneumonia（GIP）.Methods The clinical,radiological,and pathological data of two patients with GIP pathologically proven by open lung and TBLB biopsy were presented respectively,and relevant literatures were reviewed.Results Patients with GIP usually had a history of exposure to metal dust.Clinical presentations included cough and dyspnea on exertion,and pulmonary function testing showed a restrictive abnormality.On chest radiography and high-resolution CT scans,it presented as bilateral areas of ground-glass attenuation,areas of consolidation,diffuse small nodules,extensive reticular opacities,and traction bronchiectasis.The main pathological findings included a desquamative interstitial pneumonia（DIP）-like reaction with intra alveolar macrophages and numerous large multinucleated histiocytes that ingested inflammatory cells were admixed with macrophages.The finding of GIP was almost pathognomonic for hard metal pneumoconiosis.Conclusions GIP is a very rare chronic interstitial pneumonia,and has no characteristic clinical manifestations.Radiographic findings are similar to other idiopathic interstitial pneumonias.Careful collection of the occupational history can help to minimize misdiagnosis.
出处
《中国呼吸与危重监护杂志》
CAS
2011年第4期350-353,共4页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
间质性肺疾病
巨细胞间质性肺炎
尘肺
硬金属
Interstitial lung disease
Giant cell interstitial pneumonia
Pneumoconiosis
Metals
