肺泡蛋白沉着症动态CT表现及临床意义邹利光，杨华，戚跃勇，龚明福.doc

肺泡蛋白沉着症动态CT表现及临床意义 邹利光，杨 华，戚跃勇，龚明福，梁开运 （400037 重庆，第三军医大学新桥医院放射科） [摘要] 目的 回顾分析肺泡蛋白沉着症（pulmonary alveolar proteinosis, PAP）患者的胸部CT和临床资料，探讨胸部CT表现的动态变化及其临床意义。方法 PAP患者15例，男6例，女9例，年龄17~53岁，平均37.8岁。12例经临床资料和支气管肺泡灌洗证实，3例经支气管镜或经皮肺穿刺活检病理证实。15例患者共接受26次胸部CT检查，其中1、2、3次胸部CT检查分别为7、5、3例，所有病例均行肺功能检查。10例共行34次支气管肺泡灌洗（bronchoalveolar lavage，BAL），每例BAL治疗1~6次，7例BAL后复查胸部CT。结果 所有病例双肺可见广泛分布的实变影或磨玻璃影，13例次胸部CT见“碎石路”征，即肺部磨玻璃影背景下伴有网状影，12例次小叶间隔增厚，9例次肺纤维化。多数病例肺部病变分布不均呈“地图样”，部分病例肺部病变呈均匀弥漫分布。BAL治疗后复查CT，肺部病变明显好转，病变范围缩小，密度减低。结论 肺泡蛋白沉着症CT典型表现为双肺广泛分布的实变影、磨玻璃影和“碎石路”征，BAL治疗前后动态CT检查有助于明确诊断和疗效评价。 [关键词] 肺泡蛋白沉着症；支气管肺泡灌洗；体层摄影术，X线计算机 Dynamic CT and clinical significance of pulmonary alveolar proteinosis Zou Liguang, Yang Hua, Qi Yueyong, Gong Mingfu, Liang Kaiyun (Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China) [Abstract] Objective To review dynamic chest CT characteristics and the clinical significance of pulmonary alveolar proteinosis (PAP). Methods CT and clinical data were reviewed in 15 cases of PAP, 6 male and 9 female with age of 17~53 yrs. 12 cases were confirmed by clinical data and bronchoalveolar lavage, 3 cases were confirmed pathologically by bronchoscopic biopsy or percutaneous puncture. Chest CT was perform 26 times in 15 cases, with 1, 2, 3 times of CT scan in 7, 5, 3 cases respectively. Pulmonary function test was performed in all cases. Bronchoalveolar lavage (BAL) was performed 34 times in 10 cases, with 1~6 times of BAL for one case. 7 cases received follow-up CT scan after BAL. Result Diffuse pulmonary consolidation or ground glass opacity was observed in all cases, “crazy paving” sign in 13 times of CT scan, thickened interlobular septa in 12 times of CT scan, pulmonary fibrosis in 9 times of CT scan. The lung lesions distributed inhomogeneously in most cases and show “geographic pattern”. In the follow-up CT after BAL, lung lesions released obviously, the disease extent diminished and the density decreased. Conclusion