Clinical features of recurrent and insidious chronic bird fancier's lung
Clinical features of recurrent and insidious chronic bird fancier's lung
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DOI：
10.1016/s1081-1206(10)61863-7
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发表时间：
2003-06-01
影响因子：
5.9
通讯作者：
Yoshizawa, Y
中科院分区：
文献类型：
--
作者：
Ohtani, Y;Saiki, S;Yoshizawa, Y
背景：慢性鸟类爱好者肺（BFL）可分为两种类型。一个亚组的患者在反复急性发作后发生间质性肺纤维化（复发性BFL），另一亚组患者无急性发作史，但有缓慢进展的慢性呼吸道疾病目的：明确两种类型BFL的临床特点，为临床诊断提供线索。我们对1992年10月至2001年3月在日本东京医科齿科大学医院接受评估的慢性BFL患者的病历进行了回顾性分析。患者进行了评估，他们的临床特征，包括历史，实验室和免疫学结果;成像;支气管肺泡灌洗;和组织学findings.Results：32例慢性BFL患者被列入本研究; 15例复发BFL和17有隐匿性BFL。复发性BFL患者倾向于在鸽舍饲养数十只鸽子，而潜伏性BFL患者可能接触室内饲养的较小鸟类。87%的复发性BFL患者和35%的隐匿性BFL患者血清中抗鸽滴提取物或虎皮鹦鹉滴提取物特异性抗体阳性。抗原诱导的淋巴细胞增殖反应在两组中均超过90%呈阳性。胸部X线检查结果表明，两组均频繁累及上肺野。在所有的隐匿性BFL的患者，诊断证实了积极的实验室控制的吸入试验results.Conclusions：隐匿性BFL可能被误诊为特发性肺纤维化，如果不仔细的历史，抗原诱导的淋巴细胞增殖，仔细的影像学评价，和实验室控制的吸入激发试验没有进行。相反，复发性BFL的临床表现与其他抗原诱导的过敏性肺炎一致。
Background: Chronic bird fancier's lung (BFL) can be subgrouped into two types. One subgroup of patients develops interstitial pulmonary fibrosis after recurrent acute episodes (recurrent BFL), and the other subgroup of patients has no history of acute episodes but has slowly progressive chronic respiratory disease (insidious BFL).Objective: To define the clinical characteristics of both types of BFL and to provide clues for diagnosis.Methods: We performed a retrospective review of the medical records of patients with chronic BFL who were evaluated between October 1992 and March 2001 at the Tokyo Medical and Dental University Hospital in Japan. Patients were evaluated for their clinical characteristics, including history, laboratory, and immunologic findings; imaging; bronchoalveolar lavage; and histologic findings.Results: Thirty-two patients with chronic BFL were included in this study; 15 patients had recurrent BFL and 17 had insidious BFL. The patients with recurrent BFL tended to breed dozens of pigeons in a loft, whereas the patients with insidious BFL were likely to be exposed to smaller birds kept indoors. Specific antibodies against pigeon dropping extracts or budgerigar dropping extracts were positive in 87% of the recurrent BFL cases and 35% of the insidious BFL cases. Antigen-induced lymphocyte proliferation was positive in more than 90% of both groups. The upper lung field was frequently involved in both groups as demonstrated by chest radiographic findings. In all of the patients with insidious BFL, the diagnosis was confirmed by positive laboratory-controlled inhalation test results.Conclusions: Insidious BFL may be misdiagnosed as idiopathic pulmonary fibrosis if a careful history is not taken and antigen-induced lymphocyte proliferation, careful imaging evaluation, and laboratory-controlled inhalation challenge testing are not conducted. In contrast, the clinical findings of recurrent BFL are consistent with hypersensitivity pneumonitis induced by other antigens.