摘要
很少的信息可以在急性支气管病变引起的组织病理学反应气道功能紊乱综合症(拉德)。我们有机会对因氯导致的RADS患者(急性暴露后60小时、15天、2个月和5个月)进行了支气管活检,并评估肺容量和支气管对甲基胆碱的反应性。1994年9月12日,一名36岁的滤水厂工人(不吸烟)突然吸入高浓度氯。他经历了直接的鼻和喉咙灼烧、胸骨后灼烧和喘息,这些症状在轮班期间和之后持续存在。两天后,他诉说胸骨后烧灼感、呼吸困难和喘息。吸气喘息记录。他的一秒钟用力呼气容积(FEV1)为预测的66%,而引发FEV1 (PC20) 20%下降的甲基胆碱激发浓度略有异常(2.5 mg.mL-1)。第二天,病人接受了支气管活检,结果显示几乎全部的上皮被纤维蛋白血渗出物所替代。医生给病人开了吸入类固醇。事故发生15天后,PC20升级为6mg . ml -1。 Bronchial biopsies showed considerable epithelial desquamation with an inflammatory exudate and swelling of the subepithelial space. Five weeks after the accident, the PC20 was normal (57 mg.mL-1). Inhaled steroids were stopped. Two months after the accident, the PC20 deteriorated to 4 mg.mL-1. Biopsies then showed regeneration of the epithelium by basal cells and there was still a pronounced inflammatory infiltrate. Inhaled steroids were restarted. Three and five months later, the PC20 was normal (24 mg.mL-1). Bronchial biopsies showed a greatly improved epithelium and reduction of the inflammatory infiltrate. This case report shows that reactive airways dysfunction syndrome can cause acute, marked, though partially reversible, histological abnormalities. Inhaled steroids may modulate changes in bronchial responsiveness in this condition.