肺泡蛋白沉积症合并尘肺病2例临床特征及 病理分析

Clinical Features and Pathological Analysis of Two Cases of Pulmonary Alveolar Proteinosis Complicated with Pneumoconiosis

摘要: 目的：探讨肺泡蛋白沉积症(PAP)合并尘肺病的临床特征、病理表现及诊疗策略。方法：分析2例经病理确诊的PAP合并尘肺病患者的临床资料。结果：两例均以进行性呼吸困难为主要表现，影像学显示双肺弥漫性病变。病例1经肺泡灌洗确诊PAP；病例2结合职业史及钙化结节提示尘肺共存。治疗采用全肺灌洗术(WLL)联合抗感染/糖皮质激素，术后氧合改善。随访显示，强化职业防护可延缓尘肺进展。结论：PAP与尘肺病共存时诊断需结合病理与职业史，WLL是有效治疗手段，长期职业防护与随访至关重要。本研究为职业性肺病合并罕见疾病的诊疗提供了参考。

Abstract: Objective: To investigate the clinical features, pathological manifestations, and diagnosis and treatment strategies of pulmonary alveolar proteinosis (PAP) complicated with pneumoconiosis. Methods: The clinical data of two patients pathologically diagnosed with PAP combined with pneumoconiosis were analyzed. Results: Both cases presented with progressive dyspnea as the main symptom, and imaging showed diffuse bilateral lung lesions. Case 1 was diagnosed with PAP via bronchoalveolar lavage; Case 2 was suggestive of coexisting pneumoconiosis based on occupational history and the presence of calcified nodules. Treatment involved whole lung lavage (WLL) combined with anti-infection therapy/glucocorticoids, resulting in improved oxygenation postoperatively. Follow-up indicated that enhanced occupational protection could delay the progression of pneumoconiosis. Conclusion: In cases of coexisting PAP and pneumoconiosis, diagnosis should integrate pathological findings and occupational history. WLL is an effective treatment, and long-term occupational protection and follow-up are essential. This study provides a reference for the diagnosis and management of occupational lung diseases complicated by rare conditions.