Journal of Diagnostics Concepts & Practice ›› 2021, Vol. 20 ›› Issue (06): 515-521.doi: 10.16150/j.1671-2870.2021.06.001
• Experts forum • Next Articles
Received:
2021-11-08
Online:
2021-12-25
Published:
2021-12-25
CLC Number:
Ⅰ:广泛肺泡损伤的证据 a. 常规胸片或计算机断层显示多叶浸润 b. 肺炎症状和体征(咳嗽、呼吸困难、呼吸急促、肺部闻及啰音) c. 肺部生理异常的证据 1. 肺泡与动脉血氧差增加 2. 新增的或限制性肺功能试验异常加剧 Ⅱ:无活动性下呼吸道感染 a. 支气管肺泡灌洗液检查细菌性病原体阴性,包括抗酸杆菌、诺卡菌和军团菌 b. 支气管肺泡灌洗检查,非致病性细菌微生物阴性 1. 病毒和真菌的常规培养 2. 巨细胞病毒和呼吸道合胞病毒培养 3. 巨细胞病毒包涵体、真菌和卡氏肺囊虫的细胞学检查 4. CMV、RSV、HSV、VZV、流感病毒、副流感病毒、腺病毒和其他生物的抗体直接荧光染色 c. 其他生物或试验阴性 1. 人偏肺病毒、鼻病毒、冠状病毒和疱疹病毒的聚合酶链反应 2. 衣原体、支原体和曲霉的聚合酶链反应 3. 曲霉菌血清半乳甘露聚糖酶联免疫吸附试验 d. 如病情许可经支气管活检 Ⅲ:无心功能障碍、急性肾功能衰竭或医源性液体超载这些可导致肺功能不全的因素 |
分类 | 好发时间 | 危险因素 | 检查 | 影像学 | 临床表现 | 治疗 |
---|---|---|---|---|---|---|
PERDS | 植入期,多在 移植后2周 | 女性、GM-CSF | HRCT | 弥漫性磨玻璃样 阴影,胸腔积液 | 低氧血症伴 发热、皮疹 | 糖皮质激素,预后好 |
DAH | 移植后11~21 d | 药物、感染、GVHD | 支气管肺泡灌洗 | 早期磨玻璃样阴影和 实变伴空气支气管征, 后期铺路石改变 | 低氧血症、咯血、 咳白痰 | 针对病因治疗,通气 支持及激素,预后差 |
COP | 移植后2~15个月, 中位108 d | 女供男、HLA 配型 不合、急慢性 GVHD | HRCT及肺功能 | 肺有实变或斑片影,可 伴有磨玻璃样和结节 样改变 | 发热、干咳和 呼吸困难 | 糖皮质激素 |
BOS | 移植后第3个月 至2年 | 移植前低FEV1/FVC、 急或慢性GVHD、无 关或女性供体、 | HRCT及肺功能 | 马赛克征、气体闭陷 征、外周支气管管壁 增厚和扩张 | 气流阻塞的 相关症状 | 免疫抑制剂,FAM 方案 |
PPFE | 移植后数月至数年 | 预处理放化疗及 GVHD | HRCT及肺功能 | 上叶纤维化伴胸膜下 及胸膜下增厚伴缩窄、 体积缩小及牵引性 支气管扩张 | 干咳、呼吸困难 | 肺移植 |
TALS | 继发于BOS、COP 及ILD | 慢性GVHD、男性、移植时年龄<38岁和使用他 克莫司 | 胸片、CT | 气胸 | 胸痛、呼吸困难 | 胸腔闭式引流 |
肺动脉高压 | 移植后2~6个月 | 放化疗损伤 | 超声心动图、 右心导管术 | 右心室增大,肺弥漫 性磨玻璃样改变 | 右心衰症状 | 类前列腺素、内皮 素受体拮抗剂等 |
PTLD | 移植后前6个月 | 去T细胞移植物、抗胸 腺细胞球蛋白使用、 GVHD等 | 血EB拷贝数、 PET/CT及活检 | PET/CT检查出现 高代谢病灶 | 发热、淋巴结 肿大及呼吸 系统症状 | 免疫抑制剂减停 及利妥昔单抗 |
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