Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan.
Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan.
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DOI：
10.1056/nejmoa1101388
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发表时间：
2011-07-21
期刊：
影响因子：
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通讯作者：
Miller RF
中科院分区：
文献类型：
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作者：
King MS;Eisenberg R;Newman JH;Tolle JJ;Harrell FE Jr;Nian H;Ninan M;Lambright ES;Sheller JR;Johnson JE;Miller RF
在这个描述性的案例系列中，来自肯塔基州坎贝尔堡的80名士兵在伊拉克和阿富汗服役期间吸入了呼吸困难，这使他们无法达到美国陆军的身体健康标准。这些士兵接受了广泛的医疗和暴露史评估、体格检查、肺功能测试和高分辨率计算机断层扫描（CT）。共有49名士兵在无创评估后接受了胸腔镜肺活检，但无法解释他们的症状。将心肺运动和肺功能测试数据与历史军事对照受试者的数据进行比较。在接受评估的士兵中，有吸入性暴露于2003年伊拉克硫磺矿火灾的历史很常见，但并非普遍。在接受肺活检的49名士兵中，所有活检样本都异常，其中38名士兵的变化诊断为缩窄性细支气管炎。在剩下的11名士兵中，除了缩窄性细支气管炎之外的诊断可以解释目前的呼吸困难。所有患有缩窄性细支气管炎的士兵胸部x线检查结果正常，但约四分之一的士兵在胸部CT上发现马赛克气陷或小叶中心结节。肺功能和心肺运动测试结果一般在正常人群范围内，但低于军事对照组。在49名先前健康的士兵中，有不明原因的用力呼吸困难和部署后运动耐受性降低，活检样本分析显示38名士兵患有弥漫性收缩性细支气管炎，这可能与吸入性暴露有关。
In this descriptive case series, 80 soldiers from Fort Campbell, Kentucky, with inhalational exposures during service in Iraq and Afghanistan were evaluated for dyspnea on exertion that prevented them from meeting the U.S. Army's standards for physical fitness. The soldiers underwent extensive evaluation of their medical and exposure history, physical examination, pulmonary-function testing, and high-resolution computed tomography (CT). A total of 49 soldiers underwent thoracoscopic lung biopsy after noninvasive evaluation did not provide an explanation for their symptoms. Data on cardiopulmonary-exercise and pulmonary-function testing were compared with data obtained from historical military control subjects. Among the soldiers who were referred for evaluation, a history of inhalational exposure to a 2003 sulfur-mine fire in Iraq was common but not universal. Of the 49 soldiers who underwent lung biopsy, all biopsy samples were abnormal, with 38 soldiers having changes that were diagnostic of constrictive bronchiolitis. In the remaining 11 soldiers, diagnoses other than constrictive bronchiolitis that could explain the presenting dyspnea were established. All soldiers with constrictive bronchiolitis had normal results on chest radiography, but about one quarter were found to have mosaic air trapping or centrilobular nodules on chest CT. The results of pulmonary-function and cardiopulmonary-exercise testing were generally within normal population limits but were inferior to those of the military control subjects. In 49 previously healthy soldiers with unexplained exertional dyspnea and diminished exercise tolerance after deployment, an analysis of biopsy samples showed diffuse constrictive bronchiolitis, which was possibly associated with inhalational exposure, in 38 soldiers.