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炎症性肠病的肺部并发症

Authors
Steven E Weinberger, MD
Mark A Peppercorn, MD
Section Editors
Kevin R Flaherty, MD, MS
Paul Rutgeerts, MD, PhD, FRCP
Deputy Editor
Helen Hollingsworth, MD
Translators
赵燕妮, 主治医师

引言

炎症性肠病(inflammatory bowel disease, IBD)与多种胃肠道外的病变有关，这些病变被称为IBD的肠外表现(表 1)。自从1976年首次报道了6例不明原因的慢性咯脓痰病例之后，呼吸道受累(虽然相对稀少)已越来越多被发现于IBD患者中[1]。

该专题将讨论IBD的肺部并发症，包括由治疗IBD的药物引起的肺部并发症。间质性肺炎的评估和诊断的方法，以及关于克罗恩病和溃疡性结肠炎的临床表现的讨论参见其他专题。 (参见“成人间质性肺疾病的诊断方法：临床评估”和“成人间质性肺疾病诊断方法：诊断性试验”和“成人溃疡性结肠炎的临床表现、诊断和预后”和“成人克罗恩病的临床表现、诊断和预后”)

流行病学

在不同的病例系列研究中，存在相关肺部疾病的溃疡性结肠炎患者和克罗恩病患者的比例各不相同[2-4]。在一项纳入52例IBD患者的病例系列研究中，肺功能测定(pulmonary function test, PFT)异常在克罗恩病患者中比在溃疡性结肠炎患者中更多见(25% vs 6%)，但计算机断层扫描结果的异常则见于约50%的溃疡性结肠炎或克罗恩病患者[3]。另一项针对33例IBD相关性肺部受累患者的病例系列研究中，27例为溃疡性结肠炎，6例为克罗恩病[2]。

发病机制

IBD相关的肺实质病变和浆膜炎的发病机制尚不清楚。不过，现认为较多见的气道炎症性改变与肠道中的炎症改变类型相同[5]。 (参见“炎症性肠病发病机制中免疫和微生物的作用机制”)

主要的呼吸系统受累

IBD的肺部并发症包括大气道和小气道的炎症、肺实质病变、浆膜炎及肺栓塞[6,7]。这些异常通常与基础性肠道病变相关，但间质性肺病(interstitial lung disease, ILD)也可能由特定药物[例如柳氮磺吡啶、美沙拉秦(5-aminosalicylic acid, 5-ASA)、甲氨蝶呤(methotrexate, MTX)、硫唑嘌呤(azathioprine, AZA)和英夫利西单抗]的使用而引发[8-12]。IBD患者可出现咳嗽、呼吸困难、胸痛或因其他原因获取胸片时发现的胸片表现异常。初步病史(包括目前用药)和体格检查通常会集中于特定的肺部受累类型上(如气道受累 vs 肺实质受累)。

                                

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Literature review current through: 2017-07 . | This topic last updated: 2016-07-08.
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