重癥間質(zhì)性肺病診斷與治療-精美PPT

1、梅河口市新華醫(yī)院梅河口市新華醫(yī)院DPLD/ILDDPLD/ILD肉芽腫疾病肉芽腫疾病結(jié)節(jié)病、結(jié)節(jié)病、LCH膠原血管疾病膠原血管疾病肺腎綜合征肺腎綜合征吸入因素吸入因素職業(yè)（有機(jī)無(wú)機(jī)）職業(yè)（有機(jī)無(wú)機(jī)）環(huán)境（包括家居）環(huán)境（包括家居）氣體蒸汽氣溶膠氣體蒸汽氣溶膠愛(ài)好鳥寵物愛(ài)好鳥寵物遺傳因素遺傳因素家族性家族性IPF結(jié)節(jié)性硬化結(jié)節(jié)性硬化神經(jīng)纖維瘤病神經(jīng)纖維瘤病代謝儲(chǔ)存病代謝儲(chǔ)存病某些特異性疾病某些特異性疾病PAP癌性淋巴管炎癌性淋巴管炎LAM / IPH肺靜脈阻塞性疾病肺靜脈阻塞性疾病醫(yī)源性（藥物放射）醫(yī)源性（藥物放射）特發(fā)性間質(zhì)性肺特發(fā)性間質(zhì)性肺炎（炎（IIP）感染感染* 病毒病毒非典型病原體非典

2、型病原體PCP繼發(fā)于其他系統(tǒng)繼發(fā)于其他系統(tǒng)疾病疾病 消化、腎消化、腎臟、血液等臟、血液等Adapted from Ryu JH, et al. Mayo Clin Proc. 1998;73:1085-1101.Adapted from ATS/ERS. Am J Respir Crit Care Med. 2002;165:277-304.1970s2003IdiopathicIPsHeterogeneousgroup that includeda number ofdiseasesUIP/IPFNSIPDIPRB-ILDAIPCellularFibroticInterstitial Lun

3、g DiseasesSarcoidosisHypersensitivity PneumonitisAsbestosisLAMBMLLGCOPLIP特發(fā)性間質(zhì)性肺炎（IIP）特發(fā)性肺纖維化（IPF/UIP）除 IPF 以外的特發(fā)性間質(zhì)性肺炎呼吸性細(xì)支氣管炎伴間質(zhì)性肺?。≧BILD）隱原性機(jī)化性肺炎（COP）脫屑型間質(zhì)性肺炎（DIP）急性間質(zhì)性肺炎（AIP）非特異性間質(zhì)性肺炎（NSIP）淋巴細(xì)胞間質(zhì)性肺炎（LIP）特發(fā)性間質(zhì)性肺炎的分類特發(fā)性間質(zhì)性肺炎的分類AIPARDSAIP05010015020025030045-5455-6465-7475+MaleFemale020406080100120

4、45-5455-6465-7475+MaleFemalePrevalenceIncidencePer 100,000Per 100,000 Incidence: 30,000 patients/year Prevalence: 80,000 current patients Age of onset: most 4070 years Two-thirds 60 years old at presentation Males femalesATS/ERS. Am J Respir Crit Care Med. 2000;161:646-664.Raghu G, et al. Am J Respi

5、r Crit Care Med. 2006;174:810-816.UIP 時(shí)間和空間分布不一致 肌成纖維（纖維母）細(xì)胞灶 不同程度間質(zhì)的炎癥和膠原纖維 沉積指征指征方案方案PCPCMV1. AcuteP.EdemaPneumonia2. Pleural effusion1.pulmonary edema2.lymphangitic carcinomatosis3.lymphoma4.collagen vascular disease3.PneumothoraxlymphangioleiomyomatosisLCH4.Predominantly Below with reduced volum

6、e1.Asbestosis2. Aspiration (chronic)3. Pulmonary fibrosis (idiopathic)4.Collagen vascular disease鑒別診斷需要參考的其他方面鑒別診斷需要參考的其他方面5. A middle or upper lung predominant1.Mycobacterial or fungal disease2.Silicosis3.Sarcoidosis4.Langerhans Cell Histiocytosis6. Associated lymphadenopathy1.Sarcoidosis2.neoplasm (lymphangitic carcinomatosis, lymphoma, metastases)3. infection (viral, mycobacterial, or fungal)4. silicos