小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
其他诊断因素
- 劳力性呼吸困难
- 咳嗽
- 胸部检查正常
- 胸部听诊时有湿啰音
- 胸闷和/或哮鸣
- 胸部听诊时发现有呼气延长和哮鸣
- 胸部叩诊时有浊音区
- 紫绀
- 桶状胸
- 咯血、发热或盗汗
- 杵状指和趾
- 体重减轻
- 类风湿关节炎或硬皮病的体征
- 肾功能衰竭的体征（例如：体重升高、水肿、高血压）
危险因素
- 二氧化硅的职业暴露
- 煤的职业暴露
- 铍的职业暴露
- 吸入性二氧化硅或煤的高累积剂量
- 吸烟
- HLA-DP1 β 链第 69 号位置的谷氨酸（慢性铍肺）
- 吸入铍的高累积剂量
诊断性检查
首要检查
- 胸部 X 线检查（后前位和侧位）
- 肺量测定法
- 铍淋巴细胞增殖试验 (BeLPT)
需考虑的检查
- 支气管镜活组织检查和/或灌洗
- 高分辨率胸部 CT 扫描（HRCT）
- 血氧饱和度
- 动脉血气 (arterial blood gas, ABG)分析
- 肺活组织检查
- 结核病（TB）检测
治疗流程
急性继发性肺泡蛋白沉积症（急性硅肺病）
急性铍中毒
慢性硅肺病、煤工尘肺或慢性铍中毒
撰稿人
作者
Kenneth D. Rosenman, MD
Professor of Medicine
Division of Occupational and Environmental Medicine
Michigan State University
East Lansing
MI
利益声明
KDR has given expert testimony in the past. He has active grants from Materion to research natural history of beryllium disease and from the National Institute for Occupational Safety and Health to conduct public health surveillance of occupational lung disease. KDR is an author of several references cited in this topic.
同行评议者
Ware G. Kuschner, MD
Associate Professor of Medicine
Stanford University
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
利益声明
WGK declares that he has no competing interests.
Harman Paintal, MBBS
Division of Pulmonary and Critical Care Medicine
Veterans Affairs Palo Alto Health Care System (VAPAHCS)
Palo Alto
CA
利益声明
HP declares that he has no competing interests.
Francis Thien, MD, FRACP, FCCP
Professor
Box Hill Hospital and Monash University
Victoria
Australia
利益声明
FT declares that he has no competing interests.
Edward L. Petsonk, MD
Professor of Medicine
Section of Pulmonary and Critical Care Medicine
West Virginia University School of Medicine
Morgantown
WV
利益声明
ELP declares that he has no competing interests.
Christopher M. Barber, BM, BS, BMedSci, FRCP, MD, AFOM
Respiratory Consultant
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield
UK
利益声明
CMB declares that he has no competing interests.
Carl J. Reynolds, MBBS, MRCP, BSc, MSc, PhD, DPMSA
Respiratory Consultant
Honorary Senior Clinical Lecturer
North Middlesex University Hospital
Imperial College London
UK
利益声明
CJR declares that he has no competing interests.
鉴别诊断
- 石棉肺
- 特发性肺纤维化
- 结节病
更多 鉴别诊断指南
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