间质性肺疾病课件.ppt

间质性肺疾病GoldSSZMTXSjogren’ssyndromRAorganizingpneumonia间质性肺疾病实变、磨玻璃影间质性肺疾病33%ofwithRAassociatedparenchymallungdisease31IPFRadiography:2-6%29HRCT:10%-47%35-8HRCT:50%withbroncioectasesandbronchiolectasisRA间质性肺疾病LIPisuncommon少见,beingseenmainlyinpatientswithdysproteinemia,autoimmunedisease自身免疫性疾患,particularlySjogren‘ssyndrome,andpatientswithAIDS.LIPmaybea“pre-lymphomatous”condition,exceptinpatientswithAIDS.Itoftenpresentswithnoduleshavingaperilymphaticdistribution结节淋巴管周围分布.间质性肺疾病与ILD的相关因素与病种有关在RA中与RF的滴度有关DM/PM与抗Jo-1抗体有关抗RNP抗体ClinExpAllergy2003;33:226~232ArthritisRheum2002;47:614~622间质性肺疾病肉芽肿性ILD间质性肺疾病EAA过敏过敏原抗体T细胞、巨噬细胞症状咳嗽、气短全身炎症反应HRCT弥漫性磨玻璃样变小叶中心性微结节纤维化、肺气肿肺功能限制性通气功能障碍弥散功能、低氧血症BALF淋巴细胞CD4/CD81肺活检非坏死性肉芽肿细支气管周围间质性肺疾病外围结节间质性肺疾病结节病症状发热、乏力、体重下降干咳、呼吸困难、咯血淋巴结、皮肤、心脏、眼部、神经、肾脏、肝脏、脾脏、腮腺、关节、生殖系统实验室检查LNSACE血钙、尿钙、ALPPPD（-）支气管镜检查TBLBBALFCD4/CD83肺功能晚期限制性弥散组织活检*Notetheperipheralcoarsehoneycombpatternthatisthehallmarkofusualinterstitialpneumoniaandassociatedwithfibroblasticfocionhistopathologicassessment.

*Largenumbersofcystshavereplacedlungtissue.Thesearethehallmarksofresolvedlymphocyticinterstitialpneumonia*Thereismosaicperfusion.Areasofnormalorincreasedattenuationareadjacenttoareasofsignificantlydecreasedattenuationduetotheabsenceofbloodflow(whitearrows).Thisisduetohypoxicvasoconstriction.

*.Notethebilateralareasofconsolidation,whichareperipheralandinthelowerzones(arrowheads).

*?.Notethediffusereticularpatternparticularlyontheleft.Inaddition,ontheright,thereisbronchiectasis,whichispresentindependentoffibrosis(whitearrow).Thisconstellationofairwaydiseaseandparenchymalreticularchangeistypicalofrheumatoidarthritis.

间质性肺疾病间质性肺疾病间质性肺疾病概念弥漫性实质性肺疾病（DPLD）间质性肺疾病（ILD）间质性肺炎（interstitialpneumonias）