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find Keyword "间质性肺炎" 20 results
  • 造血干细胞移植后间质性肺炎18例分析

    间质性肺炎(IP)是造血干细胞移植后严重的并发症之一,临床表现缺乏特异性,病情重,死亡率高,直接影响造血干细胞移植患者的移植后存活率。现对四川大学华西医院1999~2005年期间110例造血干细胞移植患者中发生IP的18例患者临床资料进行回顾性分析,探讨其发病相关危险因素及防治措施

    Release date:2016-09-14 11:56 Export PDF Favorites Scan
  • 急性间质性肺炎的治疗进展

    急性间质性肺炎( acute interstitial pneumonia, AIP) 是一种突发起病、快速进展为呼吸衰竭并需机械通气的间质性肺疾病, 其病理特点为弥漫性肺泡损伤。最早在1944 年Hamman和Rich[ 1] 报告了一组以暴发起病、进展迅速并短时间内死亡为特点的病例, 在病理上主要表现为肺泡间隔增厚水肿、通明膜形成及肺间质广泛纤维增生, 此后有人称此为Hamman-Rich 综合症。1986 年Kuzenstein 等[ 2 ] 报道了8 例与Hamman-Rich 综合症相类似的病例, 并正式更名为急性间质性肺炎。2002 年ATS/ERS 将AIP列为特发性间质性肺炎的一个亚型。AIP 确切的病因及发病机制尚不清楚, 因其临床表现及病理特点类似于ARDS, 有人认为AIP是特发性ARDS[ 3] 。目前AIP 尚无有效规范的治疗方法, 临床上主要以大剂量糖皮质激素的应用及机械通气支持治疗为主。现结合有限的文献资料对AIP 的治疗作进一步探讨。

    Release date:2016-08-30 11:53 Export PDF Favorites Scan
  • Clinical Features and Prognosis of Secondary Lymphocytic Interstitial Pneumonia: An Analysis of Nine Cases

    【Abstract】 Objective To investigate the clinical characteristics and prognosis of secondary lymphocytic interstitial pneumonia ( LIP) . Methods Clinical data of 9 cases with secondary LIP diagnosed from1990 to 2010 were retrospectively analyzed. Results Of 9 patients there were 3 males and 6 females,the range of age was 7-64 years. In the 6 adult patients there were 5 females. 2 cases were infected by EB virus and 1 by recurrent pulmonary infection in 3 non-adult patients. In the adult patients, 1 case was diagnosed with Sjogren’s syndrome, 1 case with overlapping syndrome, 2 cases with primary biliary cirrhosis,1 case was probably caused by infection, and 1 case was complicated with eosinophilia. Dominant symptoms of pulmonary system were cough, expectoration, and shortness of breath on exertion. Dominant systematic symptoms were asthenia, pyrexia, weight lose, and arthralgia. CT revealed diffuse ground glass opacities with a lower lung zone predominance. Pathologic feature of LIP was a diffuse, polyclonal lymphoid cell infiltration surrounding airways and extending to the lung interstitium. The patients were treated by glucocorticoid and immunosuppressants. Two cases died with secondary infection. Follow-up did not comfirm malignant tumors in the survivors. Conclusions The clinical features of LIP are characteristic, but lacking of specificity. The final diagnosis depends on pathological examination. Treatment targeted on primary diseases can probably have a good efficacy, and the clinical outcome is favorable.

    Release date:2016-08-30 11:55 Export PDF Favorites Scan
  • Giant Cell Interstitial Pneumonia: Two Cases Report and Literature Reviews

    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.

    Release date:2016-08-30 11:56 Export PDF Favorites Scan
  • The Effectiveness of Transbronchial Lung Biopsy in the Diagnosis of Idiopathic Interstitial Pneumonia

    Objective To investigate the role of transbronchial lung biopsy ( TBLB) in the diagnosis and prognosis evaluation of idiopathic interstitial pneumonia ( IIP) . Methods Clinical data of IIP patients admitted to Peking University First Hospital from January 2005 to April 2009 were analyzed retrospectively. The pathologic manifestations of TBLB samples of these patients had been reviewed by pathologists and respirologists. Chest high-resolution computer tomography ( HRCT) of the patients had been reviewed, and subsequent follow-ups were performed. The influence factors on diagnosis value of TBLB were analyzed. The relationship between TBLB findings and prognosis were observed. Results 29 IIP patients had been investigated, among them 21 were male and 8 were female, ranging in age from 43 to 79 years, with an average of 63 ±10 years.16 TBLB samples had diagnostic value, among themthe total number of the samples was from 2 to 7, with an average of 4.2 ±1.8. 13 TBLB samples had no diagnostic value, among them the total number of the samples was from0 to 5, with an average of 2.1 ±1.6. There was significant differences between two groups( P lt;0.005) . Among the 16 cases with diagnostic value of TBLB, non-specific interstitial pneumonia ( NSIP) pattern was showed in 9 cases, usual interstitial pneumonia ( UIP) pattern in 6 cases and organizing pneumonia ( OP) in 1 case. Among 29 cases, UIP-like pattern was showed on HRCT in 14 cases, while non-UIP pattern showed on HRCT in 15 cases. On follow-up of the 16 patients, 1 patient aggravated and 5 patients died among 6 cases with UIP pattern, 8 patients got better and 1 patient died among 9 cases with NSIP pattern, and the patient with OP got better. The patients who show non-UIP pattern in TBLB survived longer than UIP pattern with significant difference between two groups ( P lt; 0.005) . Conclusions The diagnosis value of TBLB is bly related to the number of samples and the patterns of HRCT. When the number of samples is more than or equal to 3, the diagnosis value of TBLB is better. It is easier to get valuable TBLB samples in patients with non-UIP pattern on HRCT than that with UIP pattern. The patients with non-UIP pattern in TBLB have better prognosis than those with UIP pattern. TBLB is useful in diagnosis and prognosis evaluation of IIP.

    Release date:2016-09-13 03:46 Export PDF Favorites Scan
  • Clinical Analysis of Sixty-Two Cases of Diffuse Parenchymal Lung Disease

    Objective To analyze the clinical symptoms, imaging, laboratory tests, efficacy and other indicators of patients diagnosed as diffuse parenchymal lung disease ( DPLD) , in order to provide a reference for differential diagnosis of secondary DPLD and idiopathic interstitial pneumonia ( IIP) .Methods Sixtytwo patients diagnosed as DPLD were retrospectively analyzed. Results In 62 patients with DPLD, 19 patients ( 30. 6% ) were diagnosed as secondary DPLD, 42 cases ( 67. 7% ) as IIP, 1 case ( 1. 6% ) as Langerhans cell histiocytosis. The smoking rate of the DPLD patient was 33. 8% , which was higher than general population ( 29. 7% ) . 94. 7% of the secondary DPLD patients had cough, which was higher than the IIP patients ( 71. 4%) . The average age of onset of the secondary DPLD and IIP was ( 45. 9 ±16. 8) years and ( 60. 5 ±7. 7) years respectively, without significant difference ( P gt; 0. 05) . Etiological factors of secondary DPLD were dust, pets, drugs, pesticides, decoration material, etc. The secondary DPLD patients had higher response rate to steroid therapy, but had no statistical difference compared with the IIP patients ( 46. 2% vs. 37. 5% , P gt;0. 05) . Conclusions As a group of diseases of known causes, history taking is very important for DPLD diagnosis and differential diagnosis. Clinical symptoms, imaging, and laboratory tests may provide reference for differential diagnosis of secondary DPLD and IIP.

    Release date:2016-09-13 04:00 Export PDF Favorites Scan
  • A Comparative Study on Connective Tissue Diseases Related Interstitial Lung Diseases and Idiopathic Interstitial Pneumonias

    ObjectiveTo compare the clinical characteristics,high-resolution computed tomography (HRCT) manifestations,pulmonary function results,serum autoantibodies and treatment modality of connective tissue diseases related interstitial lung diseases (CTD-ILDs) and idiopathic interstitial pneumonias (ⅡPs). MethodsPatients explicitly diagnosed with CTD-ILDs and ⅡPs were retrospectively selected from Nanjing Drum Tower Hospital between January 2004 and December 2012.The clinical features were abstracted,including age,gender,symptoms,signs,serum autoantibody results,HRCT findings,and treatment.Patient characteristics were compared between CTD-ILDs and ⅡPs using a Pearson's χ2 test for categorical variables,and a Student's t test for continuous variables. ResultsA total of 692 patients with complete data were included in this study,with 240 CTD-ILDs cases and 452 ⅡP cases.CTD-ILDs could exist in different types of CTDs,which were mainly shown in Sjogren's syndrome,rheumatoid arthritis,and dermatomyositis/polymyositis.Age,gender,connective tissue diseases related characteristics such as dry eyes,dry mouth,and arthralgia,and several autoantibodies such as ANA,SSA,SSB all showed significantly difference between CTD-ILDs and ⅡPs (P<0.05).However there were no significant differences in cough,dyspnea after exertion,velcro crackles on auscultation,or finger clubbing between two groups (P>0.05). The HRCT manifestations of CTD-ILDs were reticular opacities,patchy consolidation,band-like shadows,and pleural thickening.Pulmonary function tests commonly showed restrictive lung function and decreased diffusing capacity.The histopathologic findings of lung biopsies of CTD-ILDs were mostly chronic inflammatory cell infiltration,as well as hyperplasia of fibrous tissue and septal thickness.The finding of chronic inflammatory cell infiltration showed significant difference between CTD-ILDs and ⅡPs (P<0.05),while the HRCT manifestations,pulmonary function results or other histopathologic findings did not(P>0.05).The current treatment modality was corticosteroids plus immunosuppressants. ConclusionDespite the similarities,CTD-ILDs show distinct clinical,laboratory and imaging features from from ⅡPs in clinical practice.

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  • The Effectiveness of Different Biopsy Methods in Diagnosis of Idiopathic Interstitial Pneumonia

    ObjectiveTo evaluate the effectiveness of different biopsy methods in the diagnosis of idiopathic interstitial pneumonia (IIP). MethodsA retrospective analysis was performed in patients hospitalized and diagnosed as IIP between January 2010 to December 2013 in the Department of Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University. The patients were divided based on initial diagnoses. The performance of invasive examinations including both transbronchoscopic lung biopsy (TBLB) and surgical lung biopsy (SLB) and final diagnoses were recorded. ResultsThree hundred and ninety-one patients were included in the study with mean age of 62.5±11.9 years. There were 299 patients receiving TBLB, 43 patients receiving SLB, and 49 patients receiving non-invasive examinations. Among 299 patients who underwent TBLB, parenchymal tissue was not obtained in 132 (44.1%) but successfully obtained in 167 (55.9%) patients, with 79 (47.3% out of 167) clinically helpful. TBLB-based specific diagnoses were as follows:30 cases of non-specific interstitial pneumonia (NSIP), 22 cases of cryptogenic organizing pneumonia (COP), 18 cases of idiopathic pulmonary fibrosis (IPF), 4 cases of acute interstitial pneumonia (AIP), 2 cases of respiratory bronchiolitis-interstitial lung disease (RB-ILD) and lymphocytic interstitial pneumonia (LIP) for each, 1 case of desquamative interstitial pneumonia (DIP), respectively. Among 43 patients who underwent SLB, parenchymal tissue was obtained in all cases with 40(93.0% out of 43) pathologically diagnostic, including 20 cases of NSIP, 12 cases of IPF, 3 cases of COP and LIP for each, and 2 cases of RB-ILD and DIP for each. Finally, among 181 patients who failed to obtain parenchymal tissue or did not undergo invasive examination, specific diagnoses could be established in 40 patients with all finally diagnosed as IPF. ConclusionsThe pathological diagnosis, either based on TBLB or SLB, is very important in the diagnostic procedure of IIP. The biopsy technique of hospital and patient conditions should be considered when making the decision of biopsy method.

    Release date:2016-10-02 04:55 Export PDF Favorites Scan
  • Cryptogenic Organizing Pneumonia Featured by Mass and Cavity: A Case Report and Literature Review

    ObjectiveTo retrospectively analyze the clinical,pathological and imaging features of one case pathologically diagnosed as cryptogenic organizing pneumonia(COP) to improve clinical diagnosis and treatment. MethodsWith a case report and review of the related literatures,the clinical manifestations,radiological features,pathological features,differential diagnosis,management and prognosis of COP were discussed. ResultsThe clinical manifestations of COP had no specificity. The imaging manifestations were real shadows,ground glass shadows,nodules and all kinds of tape. Pathological features of lung specimen biopsy showed buds of granulation tissue within alveolar ducts and alveoli consisting of fibroblasts. Remarkable response to corticosteroids was found in this patient. The prognosis of COP was good. ConclusionsCOP is diagnosed on basis of clinical,pathologic,and imaging findings. The radiological features of COP which show mass with cavity are rare. It can be easy misdiagnosed as lung infection or tumor. The effects of ordinary anti-bacteria therapy are limited,while the corticosteroids therapy shows preferable effects. Therefore,it's important to acquire pathological evidences as early as possible to guide the diagnose and treatment.

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  • Acute Fibrinous and Organizing Pneumonia: One Case Report and Literature Review

    ObjectiveTo explore the clinical, radiological and pathological characteristics of acute fibrinous and organizing pneumonia (AFOP). MethodsA case pathologically diagnosed with AFOP in September 2013 in the Second Affiliated Hospital of Nanjing Medical University was reported, and the related literature was reviewed. ResultsA 50-year-old woman with fever, chills, cough with sputum and chest pain was admitted to this hospital. The chest CT showed the nodules and patching infiltrates of the right middle lung. The pathological examination revealed the focally exudation of fibrin, lymphocyte infiltration and the presence of foam cells within the alveolar spaces, which is different from other well-known acute lung injures such as diffuse alveolar damage, cryptogenic organizing pneumonitis, and acute eosinophilic pneumonia. Coticosteroid therapy was induced and the patient showed significantly clinical and radiological improvement. ConclusionAFOP has no specific clinical, laboratory tests and radiology features, and it's diagnosis depends on pathological examination. Treatment with coticosteroids is proved to be effective.

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