2019 年第 12 期 第 14 卷

以肺部空洞为表现的肉芽肿性多血管炎临床及影像学特征分析

Clinical and imaging characteristics of granulomatosis with polyangiitis with pulmonary cavity

作者：郑倩文王琦李君瑶高鹏

英文作者：

单位：130000长春，吉林大学第二医院呼吸与危重症医学科

英文单位：

关键词：肉芽肿性多血管炎；肺空洞；临床特征

英文关键词：

• 摘要：

• 【摘要】目的    探讨以肺部空洞为表现的肉芽肿性血管炎（GPA）的临床表现及影像学特点。方法    回顾性分析2013年1月至2018年1月吉林大学第二医院确诊的6例GPA伴肺部空洞表现的患者的临床表现、影像学特点等。结果    本组6例患者中男4例、女2例，年龄41～77岁，平均年龄54.7岁。出现咳嗽 4例，咯痰、发热、呼吸困难、咯血各3例，血尿2例，神经系统受累、眼部受累、口周溃疡各1例。胸部CT表现为空洞多发4例，单发2例（均为右侧）；空洞位于上叶4例，下叶3例；厚壁4例，厚薄不一2例；边缘不规则5例，较规则1例；空洞周围炎性渗出5例，无渗出1例；含气液平面1例；胸腔积液2例；结节3例；斑片影5例；孤岛征4例。结论    以肺部空洞为表现的GPA临床症状与其他肺部疾病无特异性区别，易于误诊；临床表现以咳嗽为主，空洞好发于右肺且多为厚壁偏心空洞。

• 【Abstract】Objective    To explore the clinical manifestations and imaging features of granulomatosis with polyangiitis(GPA) with pulmonary cavity. Methods    Clinical data and imaging findings of 6 cases of GPA with pulmonary cavity admitted to the Second Hospital of Jilin University from January 2013 to January 2018 were retrospectively analyzed. Results    There were 4 males and 2 females, with a mean age of 54.7 years(range, 41-77 years). The main clinical manifestations were cough（4 cases）, sputum（3 cases）, fever（3 cases）, dyspnea（3 cases）, hemoptysis（3 cases）, hematuria（2 cases）, nervous system involvement（1 case）, eye involvement（1 case） and perioral ulcer（1 case）. Chest CT showed 4 cases with multiple pulmonary cavities and 2 cases with single cavity in right lung; 4 cases with upper lobe cavity and 3 cases with lower lobe cavity; 4 cases with thick wall and 2 cases with different thickness; 5 cases with irregular edge and 1 case with regular edge; 5 cases with inflammatory exudation and 1 case without exudation; 1 case with air fluid level; 2 cases with pleural effusion; 3 cases with nodules; 5 cases with patchy shadows and 4 cases with isolated signs. Conclusions    Clinical manifestations of GPA involving lungs are not specific and patients with pulmonary cavity are easily misdiagnosed. The main manifestation of GPA with pulmonary cavity is cough; cavities are normally irregular with thick walls and in the right lung.