本文選題：肺泡蛋白沉積癥 + 支氣管鏡肺活檢��； 參考：《蚌埠醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的提高對肺泡蛋白沉積癥的的臨床特征的認(rèn)識,減少誤診率及漏診率,以提高臨床醫(yī)師對該病的臨床診斷率及臨床治療療效。方法對2014年至2015年在我科住院的2例肺泡蛋白沉積癥的臨床資料進(jìn)行整理、分析,并回顧性復(fù)習(xí)2006至2015年10年間發(fā)表的國內(nèi)有關(guān)本病的文獻(xiàn)資料,分析該病的年齡分布、性別構(gòu)成、危險(xiǎn)因素、臨床表現(xiàn)、誤診情況、診斷及鑒別診斷及治療情況。結(jié)果肺泡蛋白沉積癥可發(fā)生在任何年齡,男性發(fā)病多于女性,臨床表現(xiàn)主要表現(xiàn)為活動(dòng)后呼吸困難,咳嗽、咳痰,體征無或少,典型的影像學(xué)表現(xiàn)為“鋪路石”、“地圖樣”改變,確診方法主要為支氣管鏡肺活檢或肺泡灌洗液檢查,易誤診為特發(fā)性肺纖維化、肺泡細(xì)胞癌、肺炎等病,確診患者多數(shù)經(jīng)肺泡灌洗癥狀能好轉(zhuǎn)。結(jié)論1.肺泡蛋白沉積癥的臨床表現(xiàn)的特異性不強(qiáng),通常患者表現(xiàn)為臨床癥狀不典型,體征相對較輕或無,而肺部影像學(xué)改變顯著,最易誤診為特發(fā)性肺纖維化。如果臨床上遇到肺部影像學(xué)改變明顯,而臨床表現(xiàn)不典型,且抗生素、激素治療效果不佳的患者,需考慮到該病可能,需行支氣管鏡下肺活檢或支氣管鏡下肺泡灌洗明確診斷。2.粉塵接觸史及吸煙史可能是本病的危險(xiǎn)因素。3.支氣管鏡下肺組織活檢或支氣管鏡下肺泡灌洗液檢查診斷率較高,如發(fā)現(xiàn)肺泡腔內(nèi)出現(xiàn)大量過碘酸雪夫染色陽性的牛奶樣或泥漿樣物質(zhì)沉積可明確診斷。4.絕大多數(shù)患者經(jīng)肺泡灌洗治療癥狀可得到緩解,且影像學(xué)、肺功能及血?dú)夥治鼋Y(jié)果較前好轉(zhuǎn)。
[Abstract]:Objective to improve the understanding of the clinical features of pulmonary alveolar proteinosis and reduce the misdiagnosis rate and missed diagnosis rate so as to improve the clinical diagnosis rate and clinical treatment effect of pulmonary alveolar proteinosis. Methods the clinical data of 2 cases of pulmonary alveolar proteinosis hospitalized in our department from 2014 to 2015 were analyzed, and the data of domestic literature about the disease from 2006 to 2015 were reviewed retrospectively, and the age distribution of the disease was analyzed. Sex composition, risk factors, clinical manifestations, misdiagnosis, diagnosis and differential diagnosis and treatment. Results Pulmonary alveolar proteinosis can occur at any age. The incidence of pulmonary alveolar proteinosis is more in males than in females. The clinical manifestations are dyspnea, cough, expectoration, no or little signs. The typical imaging manifestations are "paving stone". "Map like" changes, the diagnosis method is mainly bronchoscopic lung biopsy or alveolar lavage fluid examination, easily misdiagnosed as idiopathic pulmonary fibrosis, alveolar cell carcinoma, pneumonia and other diseases, the diagnosis of most patients through alveolar lavage symptoms can be improved. Conclusion 1. The clinical manifestation of pulmonary alveolar proteinosis is not specific. Usually, the patients have atypical clinical symptoms, relatively mild or no signs, but the pulmonary imaging changes are significant, the most easily misdiagnosed as idiopathic pulmonary fibrosis. If the lung imaging changes are obvious and the clinical manifestation is not typical, and the effect of antibiotics and hormone therapy is not good, we should consider the possibility of the disease and make a clear diagnosis by bronchoscopic lung biopsy or bronchoscope alveolar lavage. The history of dust exposure and smoking may be the risk factors of the disease. The diagnostic rate of lung biopsy under bronchoscope or alveolar lavage fluid under bronchoscopy was higher. Most of the patients were relieved by alveolar lavage, and the results of imaging, pulmonary function and blood gas analysis were improved.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563

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相關(guān)期刊論文 前2條

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本文編號：1825372