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--> 00:02.390\n各位啊，\n\n00:02.390 --> 00:03.289\n老师大家好，\n\n00:03.289 --> 00:07.289\n那今天跟分享一下一个课件，\n\n00:07.789 --> 00:13.789\n叫外源性变异性肺泡的临床诊治与预防。\n\n00:15.710 --> 00:21.010\n那么我们接下来就会将四个方面跟大家共同学习。\n\n00:21.559 --> 00:22.360\n第一个呢，\n\n00:22.360 --> 00:22.659\n是。\n\n00:24.496 --> 00:25.695\n疾病的概述，\n\n00:26.996 --> 00:30.746\n那外源性肺泡也称为过敏性肺炎，\n\n00:30.846 --> 00:39.046\n是由反复的有机性有机性化合物引起的免疫性介导的肺部疾病。\n\n00:39.495 --> 00:42.346\n那核心的基本病理改变呢，\n\n00:42.495 --> 00:45.346\n基本是病理的组织学改变，\n\n00:45.445 --> 00:51.745\n是早期的肺泡间质肺泡和周末支气管的弥漫性单核细胞的侵润，\n\n00:52.195 --> 00:53.395\n然后出现了。\n\n00:54.055 --> 00:58.006\n肉芽肿晚期可以进化为肺间的纤维化。\n\n00:58.953 --> 01:02.054\n多发人群与就诊科室多发为好。\n\n01:02.254 --> 01:05.454\n过敏的人群就诊科室为呼吸内科，\n\n01:05.454 --> 01:06.603\n无传染性。\n\n01:07.718 --> 01:09.593\n那流行病学的特点呢，\n\n01:09.593 --> 01:16.880\n是患者比例外源性变异性的肺泡疾病患者约为0.003%，\n\n01:16.880 --> 01:23.818\n好发人群基本为长期接触有机粉尘的职业性人群，\n\n01:23.867 --> 01:27.068\n如农民、蘑菇工人啊，\n\n01:27.167 --> 01:28.068\n四哥的。\n\n01:28.819 --> 01:31.220\n养殖者性别和分布，\n\n01:31.370 --> 01:32.694\n目前资料呢，\n\n01:32.694 --> 01:33.845\n未明显的显示。\n\n01:33.845 --> 01:36.669\n本病有明显的性别的差异，\n\n01:36.769 --> 01:39.519\n也可以发生在任何年龄段。\n\n01:40.589 --> 01:41.489\n但小孩，\n\n01:41.690 --> 01:42.639\n但儿童呢，\n\n01:42.639 --> 01:43.489\n也可患病，\n\n01:43.739 --> 01:47.339\n比如说小儿的外源性应激性肺泡炎，\n\n01:48.190 --> 01:48.589\n嗯，\n\n01:48.790 --> 01:51.139\n在地区与环境因素，\n\n01:51.389 --> 01:52.540\n在有机的。\n\n01:53.448 --> 01:54.524\n污染严重的地区，\n\n01:54.524 --> 01:56.024\n比如说农业发达地区，\n\n01:56.174 --> 01:57.524\n潮湿的环境区，\n\n01:57.723 --> 01:59.624\n本病的发病机制呢，\n\n01:59.723 --> 02:00.948\n发病的特点呢，\n\n02:00.948 --> 02:01.524\n比较高。\n\n02:02.550 --> 02:05.400\n临床的分型与病程的进展，\n\n02:05.750 --> 02:07.800\n首先是急应急型。\n\n02:08.149 --> 02:14.250\n急型应急型高浓度的抗原爆发后的急性发作，\n\n02:14.350 --> 02:16.699\n接触抗原后4.6小时呢，\n\n02:16.750 --> 02:18.625\n表现为发热啊，\n\n02:18.625 --> 02:20.500\n最高温度可达到40°左右，\n\n02:20.699 --> 02:24.274\n还有干咳畏寒呼吸困难，\n\n02:24.274 --> 02:27.600\n双肺可明可闻明显的湿啰音。\n\n02:27.800 --> 02:32.949\n脱敏脱离抗原后的一日至一周缓解组织学呢。\n\n02:33.011 --> 02:38.111\n可以见肺泡及间质淋巴和间质淋巴的侵润。\n\n02:38.561 --> 02:42.712\n慢性型是长期暴露的不可逆的纤维化，\n\n02:42.861 --> 02:46.162\n由急性型转变为急性型转变，\n\n02:46.162 --> 02:51.412\n或者是长期小剂量的抗原暴露引起的表现为进行性的呼吸困难，\n\n02:51.511 --> 02:52.462\n体重下降。\n\n02:52.561 --> 02:53.287\n晚期呢，\n\n02:53.287 --> 02:55.162\n可以出现呼吸衰竭，\n\n02:55.311 --> 02:56.662\n肺心病啊，\n\n02:56.662 --> 02:57.436\n影像学呢，\n\n02:57.436 --> 02:58.311\n可以成为迷，\n\n02:58.462 --> 03:00.111\n呈现出间质。\n\n03:00.735 --> 03:01.660\n的纤维化，\n\n03:01.660 --> 03:04.785\n甚至蜂窝性的蜂窝肺的改变。\n\n03:05.386 --> 03:08.085\n亚急型是隐匿疾病，\n\n03:08.085 --> 03:10.136\n持续性的炎症症状呢，\n\n03:10.386 --> 03:15.785\n隐秘以咳嗽咳痰乏力呼吸困难伴饮食的降低，\n\n03:15.785 --> 03:16.886\n体重的下降。\n\n03:17.035 --> 03:19.235\n双肺可闻及爆破音，\n\n03:19.335 --> 03:20.136\n无发热。\n\n03:20.235 --> 03:24.085\n病理可见肉芽肿及肺泡的巨噬性细胞的激活。\n\n03:25.083 --> 03:26.233\n病程的转归呢，\n\n03:26.233 --> 03:27.958\n可以从逆展啊，\n\n03:27.958 --> 03:32.083\n可逆性炎症到慢性的纤维化急性型呢，\n\n03:32.083 --> 03:36.684\n及脱敏脱离抗原后的肺功能可恢复正常啊。\n\n03:36.684 --> 03:38.858\n亚急性若持续性的暴露呢，\n\n03:38.858 --> 03:41.958\n可进化为慢性的纤维化啊。\n\n03:41.958 --> 03:46.634\n慢性的是不可逆的肺间质的疾病预后差，\n\n03:46.783 --> 03:48.583\n需要长期的治疗。\n\n03:50.488 --> 03:52.488\n二是病因与发病机制。\n\n03:52.688 --> 03:53.037\n嗯，\n\n03:53.037 --> 03:54.938\n常见的抗原种类呢，\n\n03:55.037 --> 03:57.313\n第一个是微型类的抗原，\n\n03:57.313 --> 04:00.613\n主要是湿热放菌放放线菌，\n\n04:00.613 --> 04:02.787\n比如说普通的高温放线菌啊，\n\n04:02.888 --> 04:04.988\n干包干草小多包啊。\n\n04:06.201 --> 04:08.052\n真孢真孢菌子，\n\n04:08.102 --> 04:11.802\n比如说曲霉菌、链格孢菌等等，\n\n04:11.852 --> 04:15.227\n常见的发霉的甘草、谷物啊，\n\n04:15.227 --> 04:21.502\n甘蔗以及木纸屑空调还有湿化器的环境中，\n\n04:21.752 --> 04:26.002\n这些都可以可见我们常见的微生物类的抗原。\n\n04:26.302 --> 04:27.027\n第二点呢，\n\n04:27.027 --> 04:29.552\n是动植物的蛋白类的抗原，\n\n04:29.652 --> 04:30.627\n源于鸟类，\n\n04:30.627 --> 04:32.252\n比如说鸽子啊。\n\n04:32.884 --> 04:35.334\n鹦鹉斑鸠的血清，\n\n04:35.683 --> 04:38.259\n还有粪便、羽毛等等，\n\n04:38.259 --> 04:40.709\n还有啮齿类的排泄物啊，\n\n04:40.709 --> 04:43.683\n以及柴桑的粉丝，\n\n04:43.984 --> 04:47.884\n都可以引起我们这样的一个肺的纤维化。\n\n04:48.463 --> 04:48.764\n嗯，\n\n04:49.164 --> 04:51.688\n第三点就是化学物的抗原，\n\n04:51.688 --> 04:54.838\n比如说苯二异氢的化合物啊，\n\n04:54.838 --> 04:59.664\n邻苯二酸酐的这样一个化学工业化合物吸入后呢，\n\n04:59.664 --> 05:00.688\n半抗原的作用呢，\n\n05:00.688 --> 05:02.963\n可引起过敏性的肺泡炎。\n\n05:03.114 --> 05:06.364\n常见于化学工人的从设置从业者。\n\n05:07.276 --> 05:07.925\n第三个，\n\n05:07.925 --> 05:10.476\n我们要看一下职业与环境的暴露因素。\n\n05:10.675 --> 05:12.425\n职业化的暴露因素呢，\n\n05:12.425 --> 05:15.876\n包括典类型及典型的病种。\n\n05:16.026 --> 05:21.425\n常见的暴露包括农民肺接触发霉的干草、谷物，\n\n05:21.675 --> 05:25.976\n病原为普通的高温放射菌、热吸收链霉菌，\n\n05:26.226 --> 05:28.626\n还有蘑菇公菌、蘑菇工肺，\n\n05:28.776 --> 05:36.251\n比如说蘑菇肥料中的热放血放射放射性的线菌丝鸽公肺啊，\n\n05:36.251 --> 05:37.226\n鸟清血清。\n\n05:37.641 --> 05:38.891\n还有排泄物，\n\n05:38.941 --> 05:43.391\n羽毛中的角蛋白类的微粒抗原，\n\n05:43.691 --> 05:44.617\n湿化肺，\n\n05:44.617 --> 05:47.141\n比如说湿化气，\n\n05:47.391 --> 05:50.992\n空气中的白色湿热的放线菌，\n\n05:51.191 --> 05:51.891\n这些呢，\n\n05:51.891 --> 05:57.742\n均因环境因素的有着有机粉尘类引引发。\n\n05:58.291 --> 06:02.242\n然后就是我们家庭的环境因素的相关暴露因素，\n\n06:02.441 --> 06:07.191\n比如说家庭中可引起外源性相关的肺泡因素有湿化器。\n\n06:07.463 --> 06:09.313\n空气中的放线啊，\n\n06:09.364 --> 06:10.914\n湿热放线菌呀，\n\n06:11.114 --> 06:13.114\n以及饲养的鸟类呀，\n\n06:13.264 --> 06:14.313\n血清粪便，\n\n06:14.414 --> 06:15.989\n还有羽毛啊，\n\n06:15.989 --> 06:17.039\n粉霜等等，\n\n06:17.039 --> 06:18.063\n长期接触呢，\n\n06:18.063 --> 06:20.213\n可以导致侵润性的疾病。\n\n06:20.920 --> 06:21.170\n嗯，\n\n06:21.420 --> 06:24.769\n我们主要的抗原种菌类呢，\n\n06:24.769 --> 06:26.320\n抗原种类呢，\n\n06:26.320 --> 06:28.269\n致病的抗原种类多样性，\n\n06:28.269 --> 06:30.769\n包括微生物的类别，\n\n06:30.769 --> 06:31.970\n比如说放热菌啊，\n\n06:31.970 --> 06:33.320\n真菌孢子啊，\n\n06:33.369 --> 06:34.670\n动物蛋白等。\n\n06:35.070 --> 06:35.470\n嗯，\n\n06:35.619 --> 06:37.920\n以及细菌及产物啊，\n\n06:38.320 --> 06:42.644\n昆虫抗原及化学物的物质等，\n\n06:42.644 --> 06:47.920\n有机的粉尘灰尘都可以引发我们的这样一个疾病啊，\n\n06:48.220 --> 06:50.295\n暴露式的这样一个模式，\n\n06:50.295 --> 06:51.220\n对发病的影响。\n\n06:51.260 --> 06:52.234\n影响，\n\n06:52.234 --> 06:56.609\n接触的粉尘的强度、时间、次数是发病的重要因素。\n\n06:56.760 --> 06:59.010\n短期吸入高浓度的抗原，\n\n06:59.109 --> 07:04.385\n可以导致急性的急性型表现为接触的4.12小时内呢，\n\n07:04.385 --> 07:07.584\n反复少量或持续吸入的抗原呢，\n\n07:07.584 --> 07:10.359\n可以引起亚急性或者是慢性。\n\n07:10.559 --> 07:14.160\n慢性可以由于长期的这样一个小剂量的吸入，\n\n07:14.160 --> 07:17.660\n导致肠胃发生不可逆的肺纤维化。\n\n07:19.614 --> 07:22.164\n免疫类型的机制解析啊，\n\n07:22.164 --> 07:23.088\n可以常见，\n\n07:23.088 --> 07:28.414\n我们是三型的变态反应引起的启动的这样一个炎症吸入抗原以后呢，\n\n07:28.414 --> 07:30.864\n一直产生特异性的IGG抗体，\n\n07:30.963 --> 07:33.789\n形成免疫复合物并沉积呢。\n\n07:33.789 --> 07:36.039\n在肺泡表面上啊，\n\n07:36.039 --> 07:39.563\n激活补体的这样一个系统引起的一个炎症反应，\n\n07:39.713 --> 07:41.688\n导致肺泡间隙的水肿，\n\n07:41.688 --> 07:44.063\n炎性炎性细胞的侵润。\n\n07:44.313 --> 07:47.414\n此为疾病的早期的发病机制。\n\n07:47.951 --> 07:52.027\n那我们四型的变态反应介导的组织损伤后期呢，\n\n07:52.027 --> 07:57.802\n以T细胞介导的四型变态反应C、K、CD八和T细胞啊。\n\n07:57.802 --> 07:59.351\nCD八的T细胞呢，\n\n07:59.351 --> 08:01.601\n转化为释放炎症的因子，\n\n08:01.601 --> 08:04.502\n驱动肺干酪性的肉芽肿的形成，\n\n08:04.652 --> 08:05.326\n同时呢，\n\n08:05.326 --> 08:09.201\n激激活肺的巨噬细胞释放这样一个蛋白酶，\n\n08:09.252 --> 08:11.652\n加重肺的损伤与纤维化。\n\n08:12.809 --> 08:15.785\n免疫细胞与因子的协同作用呢，\n\n08:15.785 --> 08:19.535\n急性的我们的BLLF中呢，\n\n08:19.535 --> 08:27.010\n可见大量的CKCD八的T细胞经浆细胞及激活的肌细胞的侵蚀。\n\n08:27.109 --> 08:32.809\n炎症期间可以这个以淋巴细胞介导的间质纤维化为主。\n\n08:33.109 --> 08:38.309\n免疫细胞与炎症细胞共同参与的肺组织的破坏和功能的异常。\n\n08:39.541 --> 08:41.841\n影响发病的宿主的因素，\n\n08:41.841 --> 08:42.492\n第一个呢，\n\n08:42.492 --> 08:49.291\n是个体的免疫性状态与易感性外源性的变异性的肺泡的发病呢，\n\n08:49.541 --> 08:52.541\n与机体的免疫相关性有关。\n\n08:52.841 --> 08:54.067\n过敏的人群呢，\n\n08:54.067 --> 08:58.492\n因免疫系统的吸入性抗原的反应性增强啊，\n\n08:58.492 --> 08:59.942\n成为疾病的好发人群。\n\n09:00.242 --> 09:02.817\n免疫复合物的介导三型呢，\n\n09:02.817 --> 09:09.692\n以及T细胞共同参与参与的四型的变态反应共同发病的过程。\n\n09:10.057 --> 09:11.533\n免疫功能呢，\n\n09:11.533 --> 09:15.757\n异常可以出现肺泡的间质的炎症的损伤啊，\n\n09:15.958 --> 09:19.557\n遗传的感性遗传易感性与基因相连。\n\n09:19.757 --> 09:20.770\n研究提示呢，\n\n09:20.770 --> 09:24.507\n个体的遗传背景可能引起的这样一个发病的风险。\n\n09:24.658 --> 09:25.257\n比如说，\n\n09:25.257 --> 09:30.908\n部分的患者可以存在特定性的组织相容性抗原的系统性相关。\n\n09:31.007 --> 09:39.807\n例如鸽子的鸽子养鸽者的多发于携带HL一的这样一个基因和HL。\n\n09:40.004 --> 09:46.354\n八的这样一个基因的易感人群提示免疫反应呢在疾病中易发挥作用。\n\n09:46.604 --> 09:49.379\n基于系统的疾病发挥的影响呢，\n\n09:49.379 --> 09:53.028\n包括患者具有慢性的哮喘、哮喘的啊，\n\n09:53.028 --> 09:55.179\n支气管肺炎、支气管炎啊，\n\n09:55.179 --> 09:55.903\n慢性的阻塞，\n\n09:55.903 --> 09:57.179\n慢性肺气肿等等。\n\n09:57.179 --> 09:59.304\n这些呼吸系统的疾病人群呢，\n\n09:59.354 --> 10:01.403\n由于肺功能的基础较差，\n\n10:01.703 --> 10:04.504\n粘膜的防御力这个在下降，\n\n10:04.554 --> 10:06.229\n在接触有机粉尘时呢，\n\n10:06.229 --> 10:08.778\n更难阻挡损伤患者呢。\n\n10:08.778 --> 10:09.953\n患病率的这样一个增。\n\n10:10.020 --> 10:11.945\n加此类此类人群呢，\n\n10:11.945 --> 10:18.719\n通常不建议与这样一个机机体这个粉尘有密切接触的工作。\n\n10:20.469 --> 10:21.195\n另外呢，\n\n10:21.195 --> 10:22.469\n就是吸烟啊，\n\n10:22.469 --> 10:25.219\n吸烟对这样一个发病的双重作用，\n\n10:25.219 --> 10:31.820\n吸烟可以通过下调对肺对抗原的吸入的免疫性，\n\n10:31.869 --> 10:36.645\n在一定程度上延缓或者是防止疾病的进展。\n\n10:36.645 --> 10:37.169\n同时呢，\n\n10:37.169 --> 10:39.869\n也可以导致气道的粘膜的损伤。\n\n10:40.231 --> 10:40.632\n嗯，\n\n10:40.781 --> 10:43.281\n增加疾病的加重风险，\n\n10:43.331 --> 10:46.432\n且吸烟可以引起慢性肺炎，\n\n10:46.632 --> 10:51.632\n可能与外源性的这样一个变异性的肺泡损伤机制的叠加，\n\n10:51.632 --> 10:53.531\n加重病情的变化。\n\n10:56.192 --> 10:56.591\n嗯，\n\n10:56.742 --> 10:58.791\n最后我们来看这样一个临床表现，\n\n10:59.041 --> 11:01.791\n急性型的临床表现呢，\n\n11:01.791 --> 11:03.892\n起病的发生率，\n\n11:04.291 --> 11:06.392\n这个与潜伏期啊，\n\n11:06.392 --> 11:07.892\n急性异型呢，\n\n11:07.942 --> 11:10.791\n通常具有明确的抗原接触病史，\n\n11:10.942 --> 11:13.767\n若在抗原接触4.6小时呢，\n\n11:13.767 --> 11:17.291\n出现持续约18.24小时起病。\n\n11:18.195 --> 11:19.921\n急骤典型的表现呢，\n\n11:19.921 --> 11:23.471\n主要包括发热、畏寒、咳嗽、乏力，\n\n11:23.471 --> 11:24.270\n呼吸困难，\n\n11:24.270 --> 11:25.171\n部分患者呢，\n\n11:25.171 --> 11:27.421\n可以有这样一个哮喘的症状，\n\n11:27.421 --> 11:30.195\n约10%.20%出现此症状。\n\n11:30.346 --> 11:31.596\n体格发现呢，\n\n11:31.645 --> 11:34.745\n体格检查可以发现患者有发热，\n\n11:34.745 --> 11:35.721\n呼吸困难，\n\n11:35.721 --> 11:36.596\n甚至发干，\n\n11:36.645 --> 11:39.145\n双肺可闻及干湿啰音，\n\n11:39.145 --> 11:43.096\n甚至哮喘等这样一一种少见的病啊。\n\n11:43.976 --> 11:45.276\n症状常见有，\n\n11:45.325 --> 11:47.226\n常伴有窦性的心律过速。\n\n11:47.375 --> 11:50.976\n实验室的特点包括我们的白细胞总数的增多，\n\n11:51.026 --> 11:52.776\n以中心心粒细胞为主。\n\n11:53.075 --> 11:54.726\n支气管灌洗液中呢，\n\n11:54.726 --> 11:57.676\n以这样一个炎性细胞和淋巴细胞为主。\n\n11:57.776 --> 11:58.450\n其中呢，\n\n11:58.450 --> 12:03.625\n主要具有细胞毒性的CKB八细胞细胞啊。\n\n12:04.471 --> 12:06.622\n这样一个为主病程与转归，\n\n12:06.671 --> 12:10.947\n一般在脱离抗原或者是数日之后一周以后呢，\n\n12:10.947 --> 12:15.021\n这样一个病状的消失伴随着急症急性炎症的缓解，\n\n12:15.072 --> 12:17.822\n临床可以改变直至恢复症状。\n\n12:18.221 --> 12:18.622\n嗯，\n\n12:19.171 --> 12:23.271\n然后就是看一下我们的这个急亚型的这样一个临床的特点。\n\n12:23.880 --> 12:26.429\n包括我们这两个起病方式跟临床特点，\n\n12:26.630 --> 12:28.229\n临床为较易隐秘，\n\n12:28.229 --> 12:35.229\n都在持续和反复的抗原接触数至数月后出现病程急于急性与慢性之间，\n\n12:35.280 --> 12:41.054\n由于急性的这个急性型未及时治疗而转变为而来啊，\n\n12:41.054 --> 12:43.830\n或者是直接以这个亚急性疾病为主。\n\n12:43.929 --> 12:45.030\n核心的表现呢，\n\n12:45.030 --> 12:49.780\n也是为这样一个咳嗽咳痰进行性加加重呼吸困难为主，\n\n12:49.780 --> 12:52.080\n常伴有食欲的下降啊，\n\n12:52.080 --> 12:54.080\n易劳体重的下降等。\n\n12:54.168 --> 12:55.018\n等等，\n\n12:55.018 --> 12:56.117\n典型的体征呢，\n\n12:56.117 --> 12:58.867\n包括双性可闻及爆裂音，\n\n12:58.968 --> 13:04.442\n此为肺泡的炎症及间质性的病变的体征，\n\n13:04.442 --> 13:06.468\n常伴有这个。\n\n13:07.375 --> 13:12.526\n无效鸣音也可以无明显的杵状指咳发干病情的进展呢，\n\n13:12.676 --> 13:16.551\n若未及时的脱离这样一个过敏性的抗原呢，\n\n13:16.551 --> 13:18.375\n并干干预呢，\n\n13:18.375 --> 13:20.250\n炎症可以持续存在，\n\n13:20.250 --> 13:23.075\n进入小为不可逆的肺泡纤维化，\n\n13:23.226 --> 13:23.825\n最终呢，\n\n13:23.825 --> 13:27.526\n变为慢性出现呼吸衰竭和极其严重的并发症。\n\n13:29.270 --> 13:31.169\n慢性的亚型的特点呢，\n\n13:31.169 --> 13:35.695\n包括我们的起病方式跟临床特点可以由急性的转变而来，\n\n13:35.695 --> 13:37.619\n无急性的表现。\n\n13:37.669 --> 13:39.669\n长期小剂量的吸入抗原呢，\n\n13:39.919 --> 13:41.770\n病情进展纤维化，\n\n13:41.869 --> 13:45.270\n肺纤维化多在不可逆的阶段后才可以出现。\n\n13:45.419 --> 13:47.169\n主要表现为呢，\n\n13:47.169 --> 13:48.419\n以这样一个急性啊，\n\n13:48.419 --> 13:49.919\n进行性的呼吸困难为主，\n\n13:49.919 --> 13:50.869\n表现出乏力，\n\n13:50.869 --> 13:51.570\n食欲下降，\n\n13:51.570 --> 13:52.520\n体重下降，\n\n13:52.770 --> 13:55.219\n无明显的急症发急，\n\n13:55.270 --> 13:56.619\n急性的发热症状，\n\n13:56.619 --> 13:57.294\n晚期呢，\n\n13:57.294 --> 13:59.669\n可以出现劳力性呼吸困难及呼吸。\n\n13:59.752 --> 14:02.601\n衰竭肺心病相关的体征，\n\n14:03.252 --> 14:09.502\n肺病的症状与并发症体征可以出现弥弥漫性的爆破音。\n\n14:09.601 --> 14:12.502\n晚期的病例可以出现弥漫性的纤维化。\n\n14:12.502 --> 14:15.351\n通常出现呼吸衰竭跟肺心病的体征，\n\n14:15.502 --> 14:20.851\n如杵状指、双下肢水肿和颈动脉的怒张等等。\n\n14:22.177 --> 14:22.427\n嗯，\n\n14:22.427 --> 14:23.828\n我们儿童性的表现呢，\n\n14:23.828 --> 14:27.127\n一般是脐周的病状比较急症啊。\n\n14:27.328 --> 14:35.078\n这个儿童接受抗原数小时可以出现的症状主要表现为发热、干咳、咳痛、呼吸困难、发干，\n\n14:35.078 --> 14:40.578\n少数可以出现喘息、流鼻涕啊、流速过过敏等。\n\n14:40.578 --> 14:42.377\n体重可以发，\n\n14:42.377 --> 14:44.478\n可以减轻为明显的干湿啰音，\n\n14:44.478 --> 14:47.328\n一般无哮喘音及气气道堵塞等等。\n\n14:47.677 --> 14:48.153\n而且，\n\n14:48.153 --> 14:49.328\n小孩子的发病呢，\n\n14:49.328 --> 14:51.778\n一般与抑郁这样一个病。\n\n14:51.778 --> 14:52.578\n病毒性的肺。\n\n14:52.656 --> 14:53.356\n肺炎混浊，\n\n14:53.505 --> 14:56.481\n小儿的外源性病原变异性肺泡呢，\n\n14:56.481 --> 15:01.556\n表现为易感的病毒性的这样一个肺炎相混浊。\n\n15:01.656 --> 15:07.556\n需要结合病史、血清史啊、血清学的这样一个检查及肺功能进行筛查，\n\n15:07.705 --> 15:10.755\n避免了延误的这样一个误诊。\n\n15:13.216 --> 15:15.216\n我们诊断与鉴别诊断呢，\n\n15:15.265 --> 15:17.541\n主要是有明确的接触史，\n\n15:17.541 --> 15:19.116\n血清存在特异性抗体，\n\n15:19.366 --> 15:24.166\n出现咳嗽咳痰、呼吸困难及肺典型的症状。\n\n15:24.315 --> 15:27.440\n肺部X片可以分辨为高分辨的，\n\n15:27.440 --> 15:32.866\n这个一个CT显示出符合外源性应急的肺泡的影像学的检查，\n\n15:33.015 --> 15:36.515\n比如说急性期的肺泡边斑点的侵润啊，\n\n15:36.616 --> 15:40.666\n慢性的肺纤维化的这样一个积食啊，\n\n15:40.716 --> 15:41.741\n次要表现呢，\n\n15:41.741 --> 15:42.966\n就是可以闻。\n\n15:43.015 --> 15:45.041\n及双肺底的这样一个爆裂音啊，\n\n15:45.041 --> 15:48.640\n肺功能提示限制性肺通气障碍，\n\n15:48.640 --> 15:50.091\n比如说肺活量下降啊，\n\n15:50.091 --> 15:52.315\n肺弥散功能的减退呀，\n\n15:52.315 --> 15:59.265\n血清的这样一个血气分析显示动脉血气的这样一个下降啊，\n\n15:59.265 --> 16:02.466\n支气管肺泡和淋巴细胞比例的升高，\n\n16:02.666 --> 16:03.366\n肺部。\n\n16:04.135 --> 16:04.435\n嗯，\n\n16:04.435 --> 16:09.036\n组织学检查可以显示外源性的这样一个应激性的肺泡的特征，\n\n16:09.185 --> 16:11.185\n吸入性的激发试验为阳性。\n\n16:11.635 --> 16:12.036\n嗯，\n\n16:12.036 --> 16:13.135\n我们的诊断流程呢，\n\n16:13.135 --> 16:18.536\n首先是详细的询问患者的职业史、环境环境暴露以及症状表现，\n\n16:18.536 --> 16:21.385\n对肺部的这样一个功能和检查呢，\n\n16:21.385 --> 16:23.710\n做行做做检检验。\n\n16:23.710 --> 16:24.361\n其次呢，\n\n16:24.361 --> 16:28.435\n去检检测患者的血清特异性抗体，\n\n16:28.635 --> 16:29.486\n必要时呢，\n\n16:29.486 --> 16:31.611\n进行肺肺支气管，\n\n16:31.611 --> 16:34.486\n肺支气管的这样一个灌洗和肺活检。\n\n16:34.752 --> 16:40.702\n最后要符合至少4次4条这样一个诊断的这个标准进行综合性的判断，\n\n16:40.702 --> 16:46.351\n排除病毒性肺炎结节病及这样一个疾病的诊断。\n\n16:46.502 --> 16:48.651\n我们的这样一个影像学的检查呢，\n\n16:48.651 --> 16:52.452\n就是双肺可以见出弥漫性的肺纹理增粗，\n\n16:52.452 --> 16:56.202\n或者是细小边缘性的散在小结节影啊，\n\n16:56.202 --> 17:00.202\n呈弥漫性的肺泡及这样一个结节的改变啊。\n\n17:00.752 --> 17:02.101\n然后亚急性呢，\n\n17:02.101 --> 17:04.501\n呈这样一个小结节的阴影表现。\n\n17:04.547 --> 17:05.947\n为网状结构的改变，\n\n17:05.998 --> 17:10.498\n无纵隔的淋巴结的淋巴结的肿大。\n\n17:10.697 --> 17:12.772\n慢性表现为肺纤维化，\n\n17:12.772 --> 17:17.897\n可以晚期可以形成蜂窝肺伴肺体积的减小。\n\n17:18.047 --> 17:20.047\n高分辨的CT的特征呢，\n\n17:20.047 --> 17:25.422\n我们的急性的亚型和急性和亚急性的这个表现呢，\n\n17:25.422 --> 17:31.348\n为大量界定不清的小叶中心性的微结节可伴磨玻璃样。\n\n17:31.447 --> 17:34.098\n慢性可见为肺的纤维化啊，\n\n17:34.098 --> 17:34.397\n如。\n\n17:34.813 --> 17:36.913\n肺小叶的容量的缩小啊，\n\n17:36.913 --> 17:39.313\n网状细胞的影状啊，\n\n17:39.364 --> 17:41.514\n比如说中心小叶的缺失啊，\n\n17:41.563 --> 17:42.764\n偶见肺气肿。\n\n","v0347cg10004d76c96aljhteokh5ak6g",1068,519,"2026-01-26 11:29:17","外源性变应性肺泡炎（过敏性肺炎） - 病因、症状与治疗指南  ","外源性变应性肺泡炎, 过敏性肺炎, 过敏性肺炎症状, 过敏性肺炎治疗, 过敏性肺炎病因, 过敏性肺炎诊断  ","外源性变应性肺泡炎（过敏性肺炎）是一种由吸入有机粉尘或化学物质引发的免疫介导性肺部疾病。本文详解其病因、典型症状（如咳嗽、呼吸困难）、诊断方法及治疗方案，帮助患者了解疾病管理与预防措施。","2026-04-29 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