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--> 00:07.067\n今天我们一起来学习一下这个特发性间质性肺炎。\n\n00:07.980 --> 00:08.730\n它的临床，\n\n00:08.730 --> 00:11.031\n首先从它的临床概念的分类，\n\n00:11.180 --> 00:12.831\n有一些诊治基础来看。\n\n00:14.477 --> 00:16.127\n特发性间质性肺疾病，\n\n00:16.476 --> 00:17.877\n俗称RLD，\n\n00:17.976 --> 00:20.177\n以这种肺泡壁为主的，\n\n00:20.177 --> 00:27.976\n这种包括肺泡周围组织和其相邻支撑结构病变的一组非肿瘤、非感染性疾病群。\n\n00:31.114 --> 00:35.465\n它的主要病变是波及这种细支气管以及肺泡。\n\n00:36.481 --> 00:36.931\n实质，\n\n00:36.981 --> 00:42.056\n因此它称为这种弥漫性的实质性肺疾病。\n\n00:42.056 --> 00:44.282\n不明原因的这种间质性肺炎，\n\n00:44.481 --> 00:47.032\n即是这种特发性间质性肺炎。\n\n00:48.825 --> 00:53.375\n看一下这个特发性肺炎的一些分类还是有，\n\n00:53.375 --> 00:55.575\n主要包括这种几大类，\n\n00:55.575 --> 00:58.424\n已知这种原因的这种间质性肺病，\n\n00:58.974 --> 01:00.700\n特发性间质性肺炎，\n\n01:00.700 --> 01:02.724\n肉芽肿性这种间质性肺炎，\n\n01:02.724 --> 01:05.449\n还有一些少见的间质性肺炎。\n\n01:05.449 --> 01:07.125\n已知原因的这种间质性肺炎，\n\n01:07.125 --> 01:09.750\n包括这种职有这种职业性的肺病，\n\n01:09.750 --> 01:10.675\n包括尘肺。\n\n01:11.232 --> 01:12.332\n药物性的肺病，\n\n01:12.382 --> 01:14.832\n结缔组织病相关的这种间质性肺炎，\n\n01:14.832 --> 01:19.082\n比如这种CTDI累积的一个间质性肺炎以及等等。\n\n01:21.398 --> 01:23.248\n在特发性间质性肺炎中，\n\n01:23.447 --> 01:27.148\n它包括特发性肺纤维化非特异性。\n\n01:27.148 --> 01:28.398\n这种间质性肺炎。\n\n01:34.342 --> 01:36.692\n以及隐源性的这种机化性肺炎。\n\n01:37.554 --> 01:40.179\n急性的间质性肺炎啊，\n\n01:40.179 --> 01:43.204\n还有一种呼吸性细支气管炎，\n\n01:43.204 --> 01:44.454\n间质性肺病，\n\n01:44.903 --> 01:46.704\n脱屑性间质性肺炎，\n\n01:47.003 --> 01:50.054\n还有一些淋巴细胞性间质性肺炎。\n\n01:50.554 --> 01:53.253\n在肉芽肿性这种间质性肺炎中，\n\n01:53.253 --> 01:55.003\n它有包括了这种结节病，\n\n01:55.153 --> 01:57.204\n外源性过敏性肺泡炎，\n\n01:57.653 --> 02:00.103\n还有温格尔这种肉芽肿等一等。\n\n02:01.097 --> 02:03.097\n在在这种少见的间质性肺炎，\n\n02:03.097 --> 02:07.547\n包括这种肺泡蛋白沉积症、肺出血肾炎综合症，\n\n02:07.697 --> 02:10.647\n就是我们常说的这种骨pass综合症。\n\n02:11.348 --> 02:14.848\n肺淋巴管这种平滑肌瘤病也会导致这种，\n\n02:14.848 --> 02:17.498\n也是属于这种少见的间质性肺炎里面，\n\n02:17.647 --> 02:20.197\n朗格汉斯组织细胞增生症，\n\n02:20.498 --> 02:24.048\n特发性这种肺含铁血黄素沉沉着症，\n\n02:24.447 --> 02:27.697\n慢性这种嗜酸性粒细胞肺肺炎。\n\n02:30.227 --> 02:33.578\n接下来我们看一下这个特发性肺纤维化。\n\n02:37.093 --> 02:39.442\n它首先有这种病理类型。\n\n02:41.238 --> 02:42.063\n原因不明啊，\n\n02:42.063 --> 02:42.988\n遗传啊，\n\n02:43.388 --> 02:44.087\n吸烟，\n\n02:44.087 --> 02:45.238\n环境暴露啊，\n\n02:45.238 --> 02:46.087\n病毒感染，\n\n02:46.087 --> 02:48.212\n胃食管反流发病机制，\n\n02:48.212 --> 02:51.938\n它是包括这种肺泡这种免疫反应。\n\n02:53.391 --> 02:57.891\n还有炎症以及肺实质损伤和肺损伤的肺泡修复。\n\n02:58.742 --> 02:59.766\n临床表现中，\n\n02:59.766 --> 03:03.341\n它好发于50岁以后进行性的呼吸困难，\n\n03:03.341 --> 03:07.742\n干咳、两肺底歪口、罗音、杵状指。\n\n03:08.641 --> 03:09.817\n在肺功能方面，\n\n03:09.817 --> 03:13.492\n它表现出这种限制性的通气功能障碍，\n\n03:13.492 --> 03:15.742\n肺活量、肺总量的一个减少，\n\n03:16.192 --> 03:17.841\n弥散功能的一个降低。\n\n03:19.126 --> 03:22.876\n在血气分析里面可以看到明显的低氧血症，\n\n03:23.175 --> 03:24.776\n二氧化碳分压降低，\n\n03:26.776 --> 03:30.076\n在支气管进这种灌洗液中可以看到，\n\n03:30.076 --> 03:33.626\n早期的淋是以早期的淋巴细胞为主。\n\n03:34.488 --> 03:36.138\n早期是以淋巴细胞为主，\n\n03:36.138 --> 03:36.912\n进展期呢，\n\n03:36.912 --> 03:38.388\n以中性粒细胞为主。\n\n03:39.666 --> 03:39.865\n嗯。\n\n03:43.054 --> 03:44.354\nIPF的影像的表现，\n\n03:44.354 --> 03:51.354\n我们看一下X线中这种双肺弥漫的分布相对对称的网状或网结节状影，\n\n03:51.654 --> 03:55.404\n多位于肺基底部、周边部或胸膜下区，\n\n03:55.804 --> 03:57.503\n多半肺容积减少。\n\n03:58.876 --> 04:02.626\n可以看到3.15mm多发囊状透亮影像，\n\n04:02.826 --> 04:03.927\n叫蜂窝肺。\n\n04:04.805 --> 04:06.305\n在高分辨率CT中，\n\n04:06.406 --> 04:13.505\n典型的UIP病变是主要位于这个胸膜下和肺基底部异常的网格状的阴影，\n\n04:13.805 --> 04:15.255\n还有蜂窝样改变，\n\n04:15.406 --> 04:18.656\n伴或不伴牵拉性支气管扩张啊，\n\n04:18.656 --> 04:20.756\n无不符合UIP任何一项。\n\n04:22.682 --> 04:23.082\n嗯，\n\n04:23.131 --> 04:25.231\n可能是UIP的那种表现，\n\n04:25.231 --> 04:27.907\n是病变主要是累积在胸膜下，\n\n04:27.907 --> 04:28.832\n肺基底部。\n\n04:30.122 --> 04:31.671\n异常的网格状阴影，\n\n04:32.071 --> 04:33.421\n蜂窝样的改变，\n\n04:33.671 --> 04:36.622\n伴或不伴这种牵拉性支气管扩张。\n\n04:38.511 --> 04:43.712\n不符合这种UIP的表现是病变主要分布在中上肺叶，\n\n04:43.812 --> 04:46.712\n病变主要沿支气管血管束分布，\n\n04:47.062 --> 04:49.212\n广泛的磨玻璃样阴影，\n\n04:49.411 --> 04:50.962\n大量的微结节影，\n\n04:51.661 --> 04:54.361\n上侧或上肺也分布的这种表现。\n\n04:54.611 --> 05:01.111\n散在的囊状病变多发双侧远离蜂窝肺区域弥漫的马赛克针，\n\n05:01.212 --> 05:06.161\n或者说是有气体的腺壁支气管肺段肺叶的实变。\n\n05:19.622 --> 05:22.096\n诊断标准主要包括以下几点，\n\n05:22.096 --> 05:26.546\n排除了其他已知的这种间质性肺病肺炎的原因，\n\n05:26.546 --> 05:29.721\n包括职业性药物性结缔组织病等等。\n\n05:29.971 --> 05:34.272\n它第二点是未型这种外科活检的患者，\n\n05:34.272 --> 05:37.872\n高分辨率CT呈一个典型的UIP所见，\n\n05:38.321 --> 05:40.346\n进行了这种外外科活检，\n\n05:40.346 --> 05:45.321\n然后高分辨率CT和肺活检病理类型符合一个特定的这种组合。\n\n05:47.765 --> 05:50.415\n在治疗方面有这种乙酰半胱氨酸，\n\n05:50.565 --> 05:52.815\n硫唑嘌呤和泼尼松联合，\n\n05:53.114 --> 05:55.765\n单用这个乙酰半胱半胱氨酸。\n\n05:56.661 --> 05:57.861\n还有这种抗凝治疗，\n\n05:57.861 --> 05:59.111\n还有就是抗纤维化，\n\n05:59.111 --> 06:00.611\n比非尼酮啊，\n\n06:00.611 --> 06:01.636\n急性加重期呢，\n\n06:01.636 --> 06:03.411\n我们可以这种使用这种激素。\n\n06:06.282 --> 06:06.358\n嗯，\n\n06:06.358 --> 06:11.458\n我们再看一下这种非特异性间质性肺炎NSIP这种肺炎，\n\n06:11.458 --> 06:13.833\n它对激素的治疗效果是比较好的。\n\n06:14.282 --> 06:16.083\n主要分型分为三大型，\n\n06:16.083 --> 06:19.183\n细胞型、纤维化型、混合型。\n\n06:19.683 --> 06:23.833\n它发病的这种中位年龄是普遍低于这个IPF的，\n\n06:23.933 --> 06:26.007\n大概在40.50岁。\n\n06:26.007 --> 06:29.683\nIPF我们说都是在五十五十岁以上更为常见，\n\n06:30.483 --> 06:31.433\n起病慢。\n\n06:32.204 --> 06:34.804\n干咳逐渐加重的一个呼吸困难，\n\n06:35.054 --> 06:37.005\n两肺有这种vehicle口罗音，\n\n06:37.505 --> 06:38.454\n肺功能上面，\n\n06:38.454 --> 06:41.454\n它表现出一个限制性的肺通气功能障碍，\n\n06:41.755 --> 06:43.054\n通气功能降低，\n\n06:43.554 --> 06:46.704\n肺活量、肺总量弥散功能的降低。\n\n06:47.575 --> 06:49.250\n在血气分析里面，\n\n06:49.250 --> 06:54.174\n我们可以看到它一个进行性的一个低氧二氧化碳是正常或者降低的。\n\n06:56.225 --> 06:57.975\nNSIP的影像方面，\n\n06:57.975 --> 07:00.149\n它在X线上是两下肺，\n\n07:00.149 --> 07:03.750\n主要是以两下肺为主的毛玻璃影或斑片影，\n\n07:04.299 --> 07:08.774\n也可见这种部分的这种网格状影。\n\n07:08.774 --> 07:12.549\nCT中它支持这种SNSIP的表现有以下几点，\n\n07:12.700 --> 07:14.500\n双下肺对称的分布，\n\n07:14.649 --> 07:15.649\n毛玻璃影，\n\n07:15.649 --> 07:16.700\n网状阴影，\n\n07:16.700 --> 07:18.399\n牵拉性支气管扩张，\n\n07:18.750 --> 07:20.200\n下肺体积缩小。\n\n07:20.649 --> 07:23.725\n细胞型NSIP主要是为磨玻璃影，\n\n07:23.725 --> 07:25.350\n纤维化型膜。\n\n07:25.683 --> 07:29.283\n膜膜玻璃影或其他所见的混在的能力。\n\n07:29.683 --> 07:30.033\n嗯，\n\n07:30.033 --> 07:36.183\n以下几点是不支持ISNSIP的弥漫性的小结节影囊性改变。\n\n07:37.324 --> 07:40.623\n局灶性低密度影或马赛马赛克样改变。\n\n07:43.878 --> 07:45.854\n这些影像学上的可以看看。\n\n07:54.657 --> 07:55.233\n嗯，\n\n07:55.233 --> 07:56.632\nNSP的诊断是这种，\n\n07:56.632 --> 07:59.208\n除外已知原因引起的ILD，\n\n07:59.257 --> 08:04.007\n特别是这种CT结缔组织病导致的间质性肺病，\n\n08:04.257 --> 08:06.007\n慢性过敏性肺泡炎，\n\n08:06.108 --> 08:08.007\n慢性或亚急性疾病，\n\n08:08.407 --> 08:10.108\n可发生于任何年龄，\n\n08:10.257 --> 08:11.058\n咳嗽啊，\n\n08:11.058 --> 08:11.958\n呼吸困难，\n\n08:12.507 --> 08:13.708\n也可有乏力。\n\n08:18.067 --> 08:22.643\nCT上面是两肺下叶膜玻璃影或网状影伴牵拉性支气管扩张，\n\n08:22.942 --> 08:26.192\n病变常沿支气管血管分布，\n\n08:26.692 --> 08:28.342\n组织病理是相一致，\n\n08:28.342 --> 08:30.342\n不同程度的炎症或纤维化。\n\n08:31.489 --> 08:32.439\n嗯，\n\n08:32.439 --> 08:37.039\nIPF这种与这种NSIP的鉴别要点主要在发病年龄。\n\n08:37.489 --> 08:38.314\n嗯，\n\n08:38.314 --> 08:40.189\nIPF主要是老年多见，\n\n08:40.189 --> 08:41.564\nNSIP是中老年多见。\n\n08:41.564 --> 08:44.739\n起病情况都是比较隐匿的症状的话，\n\n08:44.739 --> 08:46.739\n都有干咳呼吸困难。\n\n08:46.939 --> 08:47.939\n嗯，\n\n08:47.939 --> 08:48.338\nNSAP的话，\n\n08:48.338 --> 08:49.838\n可可有发热，\n\n08:50.289 --> 08:53.114\n杵状指的话，\n\n08:53.114 --> 08:54.739\nNsIPF的话是更常见的，\n\n08:54.739 --> 08:56.638\n在50%或到80%。\n\n08:57.338 --> 09:00.463\n在肺高高分辨率CT里面，\n\n09:00.463 --> 09:01.838\nIPF的话主要是以这种网。\n\n09:01.900 --> 09:05.450\n状影蜂窝肺双肺基底胸膜下分布，\n\n09:05.650 --> 09:10.200\n而这种NSIP主要是片状的毛玻璃影蜂窝肺比较少的。\n\n09:11.140 --> 09:14.640\n沿气管血管数分布的气管镜灌洗液中，\n\n09:14.640 --> 09:19.590\n主要是分布的细胞IPF主要是中性粒细胞，\n\n09:19.590 --> 09:20.640\nNSIP是淋巴细胞。\n\n09:21.039 --> 09:22.114\n嗯，\n\n09:22.114 --> 09:25.239\nIPF对糖皮质激素的这种反应比较差，\n\n09:25.539 --> 09:30.614\n反而NICP对激素反应比较好。\n\n09:30.614 --> 09:33.539\nNICP的治疗主要就是一个糖皮质激素泼尼松。\n\n09:35.651 --> 09:35.976\n嗯，\n\n09:35.976 --> 09:38.801\n我们再看一下这个急性间质性肺炎，\n\n09:38.801 --> 09:40.450\n它是病因不明的一种，\n\n09:40.450 --> 09:41.651\n那种起病急剧，\n\n09:41.651 --> 09:42.726\n发热咳嗽，\n\n09:42.726 --> 09:43.950\n气急机制，\n\n09:43.950 --> 09:44.801\n呼吸衰竭。\n\n09:45.200 --> 09:45.976\n病理方面，\n\n09:45.976 --> 09:49.551\n这种弥漫性的肺泡损伤分急性期、激化期，\n\n09:50.000 --> 09:51.351\n发病年龄，\n\n09:51.351 --> 09:54.051\n主要是在40岁左右发病突然，\n\n09:54.101 --> 09:55.976\n急性上呼吸道感染，\n\n09:55.976 --> 09:57.250\n发热酸痛，\n\n09:57.500 --> 09:58.176\n寒颤，\n\n09:58.176 --> 09:58.750\n咳嗽，\n\n09:58.750 --> 10:01.051\n进行性呼吸困难是本病的主要症状。\n\n10:01.450 --> 10:02.601\n气促发干。\n\n10:02.700 --> 10:03.901\n部分杵状指。\n\n10:04.250 --> 10:05.551\n有一半的患者。\n\n10:05.591 --> 10:10.666\n可以闻及V口罗音在肺功能上面表现注重限制性弥散功能，\n\n10:10.666 --> 10:19.841\n降低AIP的影像是在X线上早期双肺下野散在相对对称分布的斑片影、大片实变影或毛玻璃影，\n\n10:20.791 --> 10:26.642\n随着病情的进展扩大到中上肺野和表现出弥漫的网格和条索。\n\n10:28.604 --> 10:30.254\n在高分辨率CT上，\n\n10:30.254 --> 10:31.528\n毛玻利影、食变影，\n\n10:31.528 --> 10:33.254\n牵拉性支气管扩张，\n\n10:33.453 --> 10:34.653\n小叶间增厚，\n\n10:34.653 --> 10:36.153\n气管血管束增粗。\n\n10:42.822 --> 10:45.021\n结节影、网状影、蜂窝状影。\n\n10:49.554 --> 10:49.755\n嗯。\n\n10:51.825 --> 10:54.450\nAIP的诊断是这种急性起病，\n\n10:54.901 --> 10:56.500\n进行性的呼吸困难，\n\n10:56.700 --> 10:59.325\n持续恶化的低氧血症，\n\n10:59.325 --> 11:02.450\nCT这种心境出现的双肺弥漫浸润，\n\n11:02.700 --> 11:04.500\n牵拉性支气管扩张，\n\n11:04.651 --> 11:09.250\n无感染依据排除其他已知的这种原因的肺损伤。\n\n11:09.250 --> 11:12.976\nAIP的治疗是类似这种IPF急性加重，\n\n11:12.976 --> 11:15.450\n主要是激素以及对症支持治疗。\n\n11:16.596 --> 11:20.096\n再看一下这个隐源性机化性肺炎啊，\n\n11:20.346 --> 11:22.046\n不明原因的机化性肺炎，\n\n11:22.046 --> 11:22.896\n病因不明，\n\n11:22.896 --> 11:27.346\n感染、药物、风湿等疾病可能有关细支气管。\n\n11:28.945 --> 11:30.745\n细支气管肺泡损伤后，\n\n11:30.745 --> 11:32.846\n气道内肉芽组织过度增生，\n\n11:33.046 --> 11:34.695\n肺泡渗出物激化。\n\n11:36.130 --> 11:37.455\n在病理表现上，\n\n11:37.455 --> 11:41.630\n这种以细支气管肺泡管肺泡腔内机化性炎症，\n\n11:42.030 --> 11:44.429\n并造成片状分布均匀一致，\n\n11:44.429 --> 11:46.429\n不破坏原有的肺组织结构。\n\n11:47.286 --> 11:50.236\n临床表现主要这种亚急性起病，\n\n11:50.236 --> 11:51.310\n流感样症状，\n\n11:51.310 --> 11:51.861\n干咳，\n\n11:51.861 --> 11:53.685\n不同程度的呼吸困难，\n\n11:53.835 --> 11:56.135\n多数患者具有维尔克罗因。\n\n11:56.685 --> 11:58.935\n实验室检查是血沉增快，\n\n11:59.335 --> 12:01.786\n白细胞轻中中度增高，\n\n12:01.786 --> 12:02.486\nCRP增高。\n\n12:02.536 --> 12:05.036\n肺功能是一个限制性通气功能障碍，\n\n12:05.036 --> 12:06.335\n弥散功能降低。\n\n12:06.786 --> 12:09.486\n在血气方面多数是一个低氧血症，\n\n12:09.685 --> 12:12.736\n支气管灌洗液是淋巴细胞数增高。\n\n12:13.486 --> 12:16.435\n影像学方面多发性斑片状肺炎型。\n\n12:17.101 --> 12:20.452\n弥漫性间质肺炎型、孤立局灶型。\n\n12:20.452 --> 12:21.502\n这种肺炎型。\n\n12:23.664 --> 12:23.864\n嗯。\n\n12:25.940 --> 12:28.215\nCOP的诊断主要是一个亚急性起病，\n\n12:28.215 --> 12:29.364\n持续性的干咳，\n\n12:29.364 --> 12:31.215\n不同程度的一个呼吸困难，\n\n12:31.565 --> 12:33.565\n双肺闻及威尔克罗音，\n\n12:33.664 --> 12:34.765\n无杵状指，\n\n12:35.114 --> 12:38.414\nX线弥漫分布的肺泡或间质浸润影，\n\n12:38.515 --> 12:40.965\n具有多发性、多形性、多变性，\n\n12:42.164 --> 12:45.565\n支气管灌洗液以淋巴细胞这种数比例增加，\n\n12:45.565 --> 12:47.515\n抗感染治疗是无效的。\n\n12:49.617 --> 12:50.893\n治疗方案的话，\n\n12:50.893 --> 12:52.343\n一般是口服泼尼松，\n\n12:52.343 --> 12:55.367\n疗程在这个半半年到一年。\n\n12:57.731 --> 12:58.130\n嗯，\n\n12:58.130 --> 13:00.431\n再看一下这个呼吸性细支气管炎，\n\n13:00.431 --> 13:02.181\n这导致这种间质性肺病，\n\n13:02.531 --> 13:05.380\n这种是与吸烟是密切相关的。\n\n13:05.981 --> 13:08.031\n远端是种呼吸支气管，\n\n13:08.080 --> 13:12.281\n以及远端气腔含有大量的棕色颗粒和巨噬细胞的聚集，\n\n13:12.781 --> 13:14.231\n不累及远端气腔，\n\n13:14.231 --> 13:16.481\n明显的呼吸性支气支气管炎。\n\n13:17.098 --> 13:18.297\n肺泡间隔增宽，\n\n13:18.497 --> 13:23.473\n无纤维化或蜂窝肺病变是比较弥漫分布，\n\n13:23.473 --> 13:24.723\n累积远端气腔，\n\n13:24.723 --> 13:26.898\n呼吸性支气管炎表现较轻，\n\n13:27.648 --> 13:30.697\n临床表现是有这种吸烟时隐匿疾病，\n\n13:30.848 --> 13:32.447\n亚急性起病居多，\n\n13:32.547 --> 13:34.747\n干咳这种进行性呼吸困难。\n\n13:35.414 --> 13:37.414\n1/百4的人有杵状指。\n\n13:39.314 --> 13:42.539\n肺功能是阻塞性、限制性、混合性，\n\n13:42.539 --> 13:43.513\n通气功能障碍，\n\n13:43.713 --> 13:45.914\n弥散功能减低。\n\n13:45.914 --> 13:49.414\nCT表现主要是一个双肺弥漫分布中央支气管，\n\n13:49.414 --> 13:51.263\n周围支气管的管壁增厚，\n\n13:51.513 --> 13:53.213\n小叶增增，\n\n13:53.513 --> 13:54.814\n中心性结节影。\n\n14:00.700 --> 14:05.450\n斑驳磨磨玻璃阴影主要位于这个上叶小叶中心型肺气肿。\n\n14:06.745 --> 14:11.770\n双肺中下叶分布为主的这种弥漫性毛玻璃影和网格条索影。\n\n14:15.374 --> 14:15.999\n治疗方面，\n\n14:15.999 --> 14:17.573\n主主要是一个戒烟，\n\n14:17.573 --> 14:20.773\n因为吸烟是大部分患者都是有吸烟史的，\n\n14:20.973 --> 14:22.223\n糖皮质激素嘛，\n\n14:22.223 --> 14:25.823\n治疗这种患者肺功能受损和病情进展的患者。\n\n14:26.770 --> 14:30.869\n再看一下这个淋巴细胞性的细细胞性的间质性肺炎，\n\n14:31.219 --> 14:35.445\n间质内以淋巴细胞为主的淋巴细胞弥漫性细胞浸润，\n\n14:35.445 --> 14:38.419\n小叶间隔肺泡间隔增宽，\n\n14:38.770 --> 14:40.820\n肺泡隔增厚增宽。\n\n14:41.369 --> 14:44.770\n细支气管周围反应性淋巴滤泡的形成，\n\n14:45.119 --> 14:49.219\n严重者间质性蜂窝纤维化或蜂窝二改变，\n\n14:49.570 --> 14:51.820\n肺泡内蛋白水肿聚集。\n\n14:53.153 --> 14:59.203\n单核细胞泡沫样巨噬细胞临床表现主要是在是中老年患者，\n\n14:59.203 --> 15:00.304\n慢性起病，\n\n15:00.604 --> 15:01.229\n干咳，\n\n15:01.229 --> 15:02.854\n进行性的呼吸困难，\n\n15:03.104 --> 15:04.354\n发热、盗汗，\n\n15:04.403 --> 15:05.703\n体重也减轻。\n\n15:05.953 --> 15:07.304\n有威尔克罗因。\n\n15:08.901 --> 15:11.552\n灌洗液主要是一个淋巴细胞比例升高，\n\n15:11.802 --> 15:13.377\n肺功能是一个限制性，\n\n15:13.377 --> 15:14.327\n通气功能障碍，\n\n15:14.327 --> 15:15.502\n弥散功能减低。\n\n15:19.890 --> 15:20.289\nCT的话，\n\n15:20.289 --> 15:21.664\n主要是一个毛玻璃影，\n\n15:21.715 --> 15:24.664\n边界不清的这种小叶中心性结节影，\n\n15:24.765 --> 15:25.765\n囊状影，\n\n15:25.765 --> 15:27.414\n小叶间隔的增厚。\n\n15:28.797 --> 15:29.523\n胸片的话，\n\n15:29.523 --> 15:32.797\n是双肺下叶这种网状的结节影，\n\n15:33.348 --> 15:36.447\n治疗方面还是一个以糖皮质激素为主。\n\n15:38.070 --> 15:40.119\n看一下这个片子。\n\n15:41.385 --> 15:44.284\n箭头所指的这个都是一个典型的一个表现。\n\n15:46.135 --> 15:52.236\n以上就是我今天关于这些相关的间质性特发性间质性肺炎的一些介绍，\n\n15:52.435 --> 15:54.960\n感谢大家的一个倾听啊，\n\n15:54.960 --> 15:55.960\n谢谢啊，\n\n15:55.960 --> 15:58.935\n以后有机会再一起学习一起分享。\n\n16:03.025 --> 16:03.224\n嗯。\n\n","v0347cg10004d60rviqljht737gl6d8g",970,906,"2026-01-24 22:00:03"," 特发性间质性肺炎 - 症状、诊断与治疗全解析  "," 特发性间质性肺炎,间质性肺病,肺纤维化,ILD症状,IPF治疗,呼吸系统疾病,肺病诊断  "," 本文详细讲解特发性间质性肺炎（IIP）的病因、典型症状、诊断方法及最新治疗方案，帮助患者了解疾病进展与日常管理建议，提升对间质性肺病的科学认知。","2026-02-12 15:30:00",[37],{"menuId":38,"menuName":39,"parentId":17,"orderNum":40,"path":41,"component":42,"isFrame":43,"isCache":44,"menuType":45,"visible":22,"status":17,"createDept":6,"remark":25,"createTime":46,"children":47,"columnImage":48,"columnLogo":49,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":50,"seoKeywords":51,"seoDescription":52,"contentNum":6,"promotionalPoster":53,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":54,"routerPath":41,"componentInfo":42},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 10:31:58",[],"https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:09:40/0d7fcb56-3dc4-4dcb-99ca-a5d5c438378e.png","https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:09:43/958efac7-dd02-4681-b8fd-0dd84b1bbf42.png","健康科普视频大全,了解你的健康生活","健康科普视频, 戒烟视频, 饮食健康视频, 胸痛科普, 用药知识, 职业健康视频, 贫血科普, 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