ILD ´ëÀå°æ Á¤¸®
1. ILD¸¦ À¯¹ßÇÏ´Â ´ëÇ¥Àû Ç×»ýÁ¦: "NSIPC"
Nitrofurantoin, Sulfonamide, INH, Penicillin, Cephalosporin
2. D-penicillamine¸¸ÀÌ BOOPÀ» ÀÏÀ¸Å²´Ù.
3. ±Þ¼ºÁõ»ó°ú ¹ß¿À» º¸ÀÌ´Â ILD?
acute eosinophilic pneumonia, hypersensitivity pneumonitis, drug-induced ILD
BOOP, acute interstitial pneumonia, acute immunologic pneumonia
4. ILD¿¡¼ steroid¿¡ ¹ÝÀÀÀÌ ÁÁÀº °æ¿ì
sarcoidosis, hypersensitivity pneumonitis, BOOP, chronic eosinophilic pneumonia
5. Æó¾ÏÀÌ Àß µ¿¹ÝµÇ´Â ILD? scar cancer = scleroderma, ankylosing spondylitis, IPF
primary or metastatic ca = PM/DM
6. pneumothorax°¡ Àß »ý±â´Â ILD
neurofibromatosis, tuberous sclerois, histiocytosis-X, lymphangioleiomyomatosis
7. idiopathic eosinophilic pneumonia
i) Loeffler's syndrome
ii) acute eosinophilic pneumonia
iii) chronic eosinophilic pneumonia
iv) Churg-Strauss disease
v) idiopathic hypereosinophilic syndrome
8. ILDÀÇ PFT
1) obstructive pattern & TLC¡è
neurofibromatosis, tuberous sclerosis, histiocytosis X, LAM, sarcoidosis
cf. hypersensitivity pneumonitis: obstructive patternÀ» º¸Àϼö ÀÖ´Ù.
2) mixed restrictive and obstructive pattern: BOOP
9. normal BAL
alveolar macrophage 80%, lymphocyte 10%(ÀÌÁß 70%°¡ T-cell)
B cell or plasma cell 1-5%, neutrophil 1-3%, eosinophil 1%
CD4/8 = 1.5
10. BAL¿¡¼ neutrophil Áõ°¡: "»õ·Î¿î CIA"
C: collagen vascular disease¿Í °ü·ÃÇÑ ILD
I : IPF, A: asbestos
11. BAL¿¡¼ lymphocyte Áõ°¡: "¾à¿¡ °ú¹ÎÇÑ ILD´Â lymphocyte°¡ Áõ°¡ÇÑ´Ù°í SBS°¡
º¸µµÇß´Ù"
¾à: drug-induced ILD, °ú¹Î: hypersensitivity pneumonitis,
S: sarcoidosis, B: berylliosis
12. BAL»ó CD4/CD8¡è: " ½Ã¹ß(SBAR), Crohn's disease°¡ CD4°¡ Áõ°¡µÈ´Ü ¸»À̰¡!"
S: sarcoidosis, B: berylliosis, A: asbestosis, R: rheumatoid arthritis
13. BAL»ó CD4/CD8¡é: BOOP
"silicosisó·³ ¾à¿¡ °ú¹ÎÇÑ ILD´Â AIDSó·³ CD4°¡ °¨¼ÒÇÑ´Ù"
¾à¹°: drug-induced ILD, °ú¹Î¹ÝÀÀ: hypersensitivity pneumonitis
14. histiocytosis X´Â ´ëºÎºÐ Èí¿¬·ÂÀÌ ÀÖ´Ù.
15. diffuse panbronchiolitis¿Í °ü·ÃÇÑ HLA: HLA Bw54
16. DPBÀÇ sputum culture
Ãʱâ: H. influenza, S. pneumoniae
ÁøÇà: P. aeruginosa
17. DPBÀÇ PFT: °æµµÀÇ Á¦ÇѼºÀå¾Ö, ½ÉÇÑ Æó¼â¼º Àå¾Ö
18. DPBÀÇ Ä¡·á·Î macrolide¸¦ ¾²´Â ÀÌÀ¯? IL-8 levelÀ» °¨¼Ò½ÃÅ´(anti-inflammatory effect)
19. diffuse alveolar hemorrhage syndromeÀ» ¾ß±âÇÏ´Â Áúȯ
i) Goodpasture's syndrome
ii) IPF
iii) SLE
iv) Wegener's granulomatosis
20. pulmonary vasculitis¿Í °ü·ÃµÈ ILD
Wegener's granulomatosis, Churg-Strauss disease, hypersensitivity vasculitis
Necrotizing sarcoid granulomatosis
21. Wegener's granulomatosisÀÇ DOC? cyclophosphamide