美国犹他州山间医疗中心的Denitza P Blagev研究小组近日取得一项新成果。他们对电子烟或蒸汽烟相关肺损伤的临床表现、治疗和短期结果进行了一系列研究。2019年11月8日，《柳叶刀》发表了这一成果。

从2019年3月开始，美国开始持续爆发电子烟或蒸汽烟相关的持续性肺损伤，目前该病的病因、诊断、治疗和病程尚未清楚。

在这项多中心、前瞻性、观察性的队列研究中，研究组收集了2019年6月27日至10月4日，在美国犹他州一个综合医疗机构-山间医疗中就诊的所有电子烟或蒸汽烟相关的肺损伤患者的临床数据，并对患者自述、治疗和短期随访数据，以及犹他州卫生部对患者的访谈数据进行了回顾与分析。

在山间医疗系统的13家医院或门诊部，共有60名患者因电子烟或蒸汽烟而导致肺损伤。60名患者中有33例（55%）被送进重症监护室（ICU），53例（88%）出现体质症状，59例（98%）出现呼吸系统症状，54例（90%）出现胃肠道症状。60例患者中有54例（90%）使用抗生素治疗，57例（95%）使用类固醇治疗。有6例（10%）患者在2周内再次入院，其中3例（50%）因再次吸电子烟或蒸汽烟而复发。

在2周内接受随访的26例患者中，尽管他们的临床和放射学检查均有所改善，但大多数患者的胸片和肺功能检查仍有残余异常。共有2例患者死亡，研究组认为电子烟或蒸汽烟相关的肺损伤是一个促成因子，但不是死亡原因。

总之，与电子烟或蒸汽烟相关的肺损伤是一种最新出现的疾病，且与严重肺损伤、体质和胃肠道症状相关。接受抗生素和类固醇治疗的患者已逐渐提高意识，发现了该病的严重程度。尽管情况稍有改善，但在短期随访中，许多患者仍有残余异常。另外，电子烟或蒸汽烟相关肺损伤的症状与传染病和其他肺部疾病有重叠，因此当出现症状时，临床医生对该病保持高度怀疑是很重要的。

附：英文原文

Title: Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study

Author: Denitza P Blagev, Dixie Harris, Angela C Dunn, David W Guidry, Colin K Grissom, Michael J Lanspa

Issue&Volume: November 08, 2019

Abstract:

Background

An ongoing outbreak of lung injury associated with e-cigarettes or vaping (also known as E-VALI or VALI) started in March, 2019, in the USA. The cause, diagnosis, treatment, and course of this disease remains unknown.

Methods

In this multicentre, prospective, observational, cohort study, we collected data on all patients with lung injury associated with e-cigarettes or vaping seen in Intermountain Healthcare, an integrated health system based in Utah, USA, between June 27 and Oct 4, 2019. Telecritical care, based in Salt Lake City, UT, USA, was used as the central repository for case validation, public reporting, and system-wide dissemination of expertise, which included a proposed diagnosis and treatment guideline for lung injury associated with e-cigarettes or vaping. We extracted data on patient presentation, treatment, and short-term follow-up (2 weeks after discharge) from chart review and interviews with patients undertaken by the Utah Department of Health (Salt Lake City, UT, USA).

Findings

60 patients presented with lung injury associated with e-cigarettes or vaping at 13 hospitals or outpatient clinics in the integrated health system. 33 (55%) of 60 were admitted to an intensive care unit (ICU). 53 (88%) of 60 patients presented with constitutional symptoms, 59 (98%) with respiratory symptoms, and 54 (90%) with gastrointestinal symptoms. 54 (90%) of 60 were given antibiotics and 57 (95%) were given steroids. Six (10%) of 60 patients were readmitted to an ICU or hospital within 2 weeks, three (50%) of whom had relapsed with vaping or e-cigarette use. Of 26 patients who were followed up within 2 weeks, despite clinical and radiographic improvement in all, many had residual abnormalities on chest radiographs (ten [67%] of 15) and pulmonary function tests (six [67%] of nine). Two patients died and lung injury associated with e-cigarettes or vaping was thought to be a contributing factor, but not the cause of death, for both.

Interpretation

Lung injury associated with e-cigarettes or vaping is an emerging illness associated with severe lung injury and constitutional and gastrointestinal symptoms. Increased awareness has led to identification of a broad spectrum of severity of illness in patients who were treated with antibiotics and steroids. Despite improvement, at short-term follow-up many patients had residual abnormalities. Lung injury associated with e-cigarettes or vaping remains a clinical diagnosis with symptoms that overlap infectious and other lung diseases. Maintaining a high index of suspicion for this disease is important as work continues in understanding the cause or causes, optimal therapy, and long-term outcomes of these patients.

DOI: 10.1016/S0140-6736(19)32679-0

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32679-0/fulltext