放射性肺炎系由于肺癌、乳腺癌、食管癌、恶性淋巴瘤或其他纵隔、胸壁的恶性肿瘤经放射治疗后，肺组织受到损伤引起的肺部炎症反应。肺部损伤的严重程度与放射剂量、肺部的照射面积以及照射速度密切相关。病理变化表现为急性期的渗出性炎症反应和慢性期的广泛肺组织纤维化。临床表现变化大，轻症者可无症状，重症者因广泛的肺纤维化病变而致呼吸功能障碍甚至死亡。肾上腺糖皮质激素对急性期炎症有一定控制作用。
放射性肺炎症状的临床表现及诊断
放射性肺炎的临床表现
1.轻者无症状，多数于放射治疗后2-3月出现症状。个别于停止放射治疗后半年始出现症状。常见的症状：刺激性乾咳;气促，活动后加剧;胸痛;伴或不伴有发热，以低热为多;引起放射性食管炎时可有吞咽困难;重症者可出现严重呼吸困难、紫绀。
2.胸部放射局部可见皮肤萎缩变硬。
3.检查肺部多数无阳性体征。当出现广泛肺纤维化时，肺泡呼吸音普遍减弱，可闻及捻发音(velcro罗音)。如继发细菌感染，可闻及干、湿性罗音。偶有胸膜摩擦音。伴发肺心病时，可有右心衰竭体征。
放射性肺炎的诊断依据
1.放射治疗史。
2.干性呛咳、进行性气急及肺部的velcro罗音具有特征性。
3.胸部x线检查可见肺部炎症或纤维化表现。多于停止放射治疗一个月后出现。急性期表现为在照射肺野出现片状或溶合成大片、致密的模糊阴影，其间隐约可见网状阴影，与支气管肺炎或肺水肿极为相似。慢性期表现为肺纤维化，呈网状，条索状或团块状收缩阴影，主要分布于肺门或纵隔两侧及其他放射肺野。由于肺纤维收缩，气管、心脏向患侧移位，同侧横膈抬高，正常肺组织产生代偿性肺气肿。发生肺动脉高压时，表现为肺动脉段突出或右心肥大。常有胸腔积液征。
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支原体肺炎的检查
常见检查项目
10-50元/次
10-50元/次
白细胞总数常在正常范围内，但偶尔亦可升高，25%患者白细胞超过10.0&109/L，少数可达(25.0～56.0)&109/L，分类以中性粒细胞或嗜酸粒细胞稍增多，血小板减少，直接库姆斯(coombs)试验可阳性，血沉在发病初期阶段可增快。
因肺炎支原体营养要求高，生长缓慢，需观察10～30天或更长时间，对临床诊断帮助不大，目前国外仍使用美国疾病控制中心(CDC)推荐的Hayflied培养基，国内多用首都儿科研究所以马丁培养基或猪肺消化液为基础的培养基。
3.血清学方法
：是诊断肺炎支原体感染广泛使用的血清学诊断方法，取急性期和恢复期双份血清效价呈4倍增长者，或单份血清效价&1∶32者判为阳，其敏感性可达90%，特异性为94%，仅初次感染时出现阳性，再次感染时常不出现阳性反应。
间接：主要检测IgM抗体，此后7天出现阳性，10～30天达高峰，12～26周逐渐降低，急性期采血宜早，否则不易测出4倍增高的抗体，特异性尚不理想，与补结试验相似。
：是一种诊断肺炎支原体感染的非特异性试验，有33%～76%感染者为阳性(效价&1∶32)，效价越高该病的可能性越大，常在发病的第一周末或第二周初出现阳性反应，持续约2～4个月，此试验在婴幼儿腺病毒，副流感病毒等引起的肺炎和呼吸道感染也可出现假阳性反应。
4.核酸杂交试验
用放射性同位素(32P，125I等)标记的核酸探针技术进行肺炎支原体检测，此法虽灵敏度高且特异性较强，但要求条件也较高，需要使用同位素，故难于在临床推广。
5.聚合酶链反应(PCR)
自1992年该法用以检查肺炎支原体感染的临床标本，从综合结果看，PCR法检测的阳性率明显高于培养法(灵敏度比普通培养法高10～100倍)，也明显高于血清学和探针杂交法，其特异性也较强，与其他支原体无交叉反应，且不受口腔其他菌污染的干扰，所需时间较短，因而采用PCR法可争取早日确诊，以指导临床合理用药，在中枢神经系统出现症状时，快速可靠的诊断更为必要，由于此法相当敏感，故实验操作时应特别小心，避免污染。
6.肺部X线检查
可见模糊云雾状或均匀一致的阴影，近肺门部较致密，向外逐渐变浅，边缘不清楚，通常不侵犯整叶，绝大多数为一叶受累，以下叶多见，左下最多，右下次之，侧位20%左右有少量胸腔积液，10%左右见肺不张，偶见胸膜炎，肺部病变通常在2～3周吸收，完全吸收需4～6周，小儿约30%伴有肺门淋巴结肿大。
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　　肺功能改变 &&& 　　肺放射性肺炎和纤维化都引起限制性通气功能障碍，肺顺应性减低，伴通气/血流比例降低和弥散功能减低，导致缺氧。有时胸片尚未发现异常，而肺功能检查已显示变化。 &&& 　　X线表现&&&　　 多数于停止放疗一月后，肺部出阴影。急性期在照射的肺野上出现弥温性片状模糊阴影，其间隐约可见网状影，酷似支气管肺炎或肺水肿。病变的范围与胸廓表面照射野一致。慢性发生肺纤维化，呈条索状或团块状收缩或局限性肺不张。纵隔胸膜和心包有大量粘连，纵隔向患侧移位，同侧横膈升高和胸廓塌陷。 &
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秋季天气变化不断，一不留神就会引起感冒，甚至引起肺炎。对于那些免疫功能发育尚未成熟的孩子来说更是吃尽了苦头。中山大学附属第六医院儿科肖昕主任提醒，秋冬季节，家长要重视小儿肺炎的防护，若发现病情要及早治疗，否则预后不良。 []
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