Objective To evaluate the efficacy and safety of whole lung lavage in the treatment of pulmonary alveolar proteinosis ( PAP) .Methods Twelve patients who were diagnosed as PAP from September 2008 to October 2011 in Hunan Occupational Disease Hospital were recruited in the study. The changes of dyspnea symptom, lung-function, arterial blood gas, and chest image were compared before and after whole lung lavage treatment. Meanwhile, the safety of lung lavage was evaluated. Results All patients were relieved from dyspnea. The lung function, hypoxia, hyperventilation, and chest image were all obviously improved. The vital signs in the process of lung lavage were stable without serious complications. Conclusion Whole lung lavage is an effective and safe treatment for PAP.
目的:肺泡蛋白沉积症(pulmonary alveolar proteinosis,PAP)是一种少见的肺部疾病,由于临床医生认识不足,容易误诊,而PAP通过灌洗治疗常常可获得较好的预后。本文通过分析PAP病例,总结PAP患者的临床特点、影像学表现和治疗方法,以提高该病的诊疗水平。方法:回顾性分析2003年2月～2008年5月四川大学华西医院呼吸科经病理确诊的15例PAP患者临床资料,并观察了全肺灌洗治疗PAP的效果。结果:PAP患者常见临床症状为咳嗽和进行性呼吸困难,体征正常或无特异性。胸部CT可表现为“地图样”、“铺路石样”或间质纤维化改变。全肺灌洗治疗的14例患者临床症状明显缓解。结论:肺泡蛋白沉积症虽然少见,但只要提高认识,诊断并不困难。支气管肺泡灌洗和(或)肺活检是确诊PAP的重要方法,全肺灌洗是治疗PAP的主要方法。
ObjectiveTo improve the diagnosis and treatment of pulmonary alveolar proteinosis (PAP). MethodsThe clinical data of 34 PAP cases diagnosed between May 2008 and June 2015 in Hunan Prevention and Treatment Center for Occupational Diseases were retrospectively analyzed. ResultsThere were 34(52.9%)patients with a history of dust exposure. Cough and progressive dyspnea were common clinical symptoms. The incidence rate of hypoxemia and lung function damage was 87.9% and 90.9%,respectively. High resolution CT clearly demonstrated the characteristic map-like changing and paving-stone sign. Arterial blood oxygen partial pressure increased from (62.5±12.9)mm Hg to (73.0±12.2)mm Hg,and DLCO%pred increased from (50.1±14.9)% to (64.6±14.4)% after large-volume whole lung lavage. The recurrence rate was 38.2%. ConclusionThe etiology of PAP is unknown,dust exposure may be associated with secondary PAP. The effect of whole lung lavage is remarkable but the recurrence rate is high. It is needed to study further on etiological treatment of PAP.