目的 探讨ICU特发性间质性肺炎患者的临床诊断要点.方法 选取本院ICU收治的37例特发性间质性肺炎患者为研究对象,以影像、病理及临床表现为依据进行诊断和分型;结合患者临床资料和既往病史,分析各病理类型的诊断要点.结果 本组病例共计非特异性间质性肺炎16例,普通特发性间质性肺炎5例,淋巴细胞性间质性肺炎4例,急性间质性肺炎4例,隐源性机化性肺炎3例,脱屑性间质性肺炎3例,呼吸性细支气管炎合并间质性肺病2例.临床表现以咳嗽为主(37例,100％),部分患者有进展性或急性呼吸困难(19例,51.4％),少数患者出现不同类型的肺内啰音(8例,21.6％),另有6例(16.2％)患者为杵状指趾.HRCT显示多数患者为弥漫性网状影病变(19例,51.4％)或磨玻璃影样病变(21例,56.8％),亦有部分结节影(11例,29.8％)和实变影(9例,24.3％).此外,2例(5.41％)患者支气管出现牵拉性扩张.肺部病理显示肺泡间隔以淋巴细胞和浆细胞浸润为主(33例,89.2％),纤维增生样病变为辅(16例,43.2％),另有少数泡沫样细胞(4例,10.8％).结论 特发性间质性肺炎病因复杂、诊治困难,各类型患者的临床、影像、病理特征既有个体化特征,又有交叉点,典型性不强,其诊断应在影像、病理及临床表现的基础上,根据患者临床资料和既往病史进行综合考虑.%Objective To discuss the key points of clinical diagnosis and treatment effect for the patients with idiopathic interstitial pneumonia in ICU.Methods Thirty-seven patients with idiopathic interstitial pneumonia in ICU in our hospital were selected.Pathological types were classified by joint diagnosis mode combined with imaging,pathology and clinical manifestation.All patients were given symptomatic treatment on the basis of their respective illness condition with glucocorticoid as the major drug.The key points of clinical diagnosis and treatment effect were analyzed according to the physical data,medical history,and clinical outcomes of patients.Results There were 16 cases of NSIP,5 cases of UIP,4 cases of LIP,4 cases of AIP,3 cases of COP,3 cases of DIP and 2 cases of RBILD in this group of patients.It showed by the clinical manifestations that all patients got cough (37,100％),some patients got acute or progressive dyspnea (19,51.4％),a few patients got different types of lung sound (8,21.6％),while 6 patients (16.2％) had clubbing toe.HRCT showed that most of the patients had diffuse reticular (19,51.4％) or ground glasslike lesion image (21,56.8％),part of them had nodular (11,29.8％) or holistic lesion image (9,24.3％).Moreover,2 cases (5.41％) of them had bronchial tractional expansion.Lung pathology showed that most patients had lymphocytes and plasma cells infiltration (33,89.2％) in the alveolar interval,while some showed fibrous hyperplasia lesions (16,43.2％),and a few patients showed foam cells like lesions (4,10.8％).Conclusion It is difficult to diagnose and treat idiopathic interstitial pneumonia with little typicality because its etiology is complicated.The characteristics of its pathological types has both individuality and intersection between each other,which indicates that the idiopathic interstitial pneumonia should be diagnosed though imaging,pathology and clinical manifestation on the basis of the patients' physical data and medical history.
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