摘要目的 探讨慢性外源性过敏性肺泡炎的病理诊断及其诊断思路.方法 收集首都医科大学附属北京朝阳医院2006年10月至2009年3月收治的、经病理确诊且有完整临床资料的慢性外源性过敏性肺泡炎7例,对其病理组织学形态和临床资料进行综合分析,并对文献进行复习.结果 7例慢性外源性过敏性肺泡炎患者,男性4例,女性3例,年龄30～65岁,平均年龄48岁,均表现为慢性起病,5例因近期加重入院,其中4例有刺激性气体或粉尘、宠物接触史；2例常见过敏原检测阳性；胸部高分辨CT显示小叶中心性小结节影及纤维条索影、磨玻璃影和小叶间隔增厚；支气管肺泡灌洗液淋巴细胞数量增高,CD4+/CD8+细胞比值＜1；肺功能检查均显示肺活量降低、肺总量降低、呼吸总气道阻力增高及周边气道阻力增高为主.5例行开胸肺活检,2例行肺移植手术.病理组织学均表现为:细支气管周围慢性炎及间质纤维化,不典型非干酪性上皮样肉芽肿,支气管腔内可见上皮样吞噬细胞渗出和新生的纤维息肉样组织形成；5例开胸肺活检的病例支气管腔内可见中性粒细胞渗出,5例均确诊为慢性外源性过敏性肺泡炎伴急性发作；2例慢性外源性过敏性肺泡炎终末纤维化期行肺移植手术.结论 慢性外源性过敏性肺泡炎组织病理学表现具有一定的诊断特征,但与其他诸多弥漫性肺实质性疾病具有相似的病理改变,须结合病史、影像学等临床信息综合分析,从而明确诊断,进行有效治疗.

abstractsObjective To study the clinicopathologic features and diagnostic approach of chronic extrinsic allergic alveolitis (EAA).Methods Seven cases of chronic EAA diagnosed by open lung biopsy or lung transplant were enrolled into the study.The clinical and pathologic features were analyzed and the literature was reviewed.Results There were altogether 4 men and 3 women.The age of the patients ranged from 30 to 65 years ( mean =48 years).All cases represented chronic form and five cases diagnosed by open lung biopsy also showed features of recent aggravation,leading to hospitalization.Four cases had known history of exposure to inciting gases,pollens and pets,and only 2 cases were positive for allergens.Highresolution CT scan showed ground-glass attenuation and reticular pattern that often had a patchy distribution and central predominance.Bronchoalveolar lavage analysis showed marked lymphocytosis,with CD4 +/CD8 + ratio less than 1.Lung function test demonstrated a restrictive ventilatory defect,with decreased compliance,reduced diffusion capacity and high airway obstruction.Five cases had open lung biopsy performed and two cases had undergone lung transplantation.Pathologic examination showed bronchiolocentric cellular interstitial pneumonia,interstitial fibrosis,non-caseating epithelioid granulomas,epithelioid histiocytic infiltrate in the respiratory bronchioles and intraluminal budding fibrosis.The five cases with open lung biopsy performed also showed neutrophilic infiltrate in the alveoli.The two lung transplant cases were complicated by severe fibrotic changes.Conclusions Chronic EAA demonstrates characteristic pathologic features.Definitive diagnosis requires correlation with clinical and radiologic findings due to possible morphologic mimicry of other diffuse parenchymal lung diseases.