使用電子煙或相關產品導致的肺損傷

E-cigarette or Vaping Pproduct Uuse-associated Lung Injury (EVALI)

葉東奇(Tung-Chi Yeh) ； 蘇一峰(Vincent Yi-Fong Su) ； 許超群(Chau-Chyun Sheu) ； 郭子右(Tzu-Yu Kuo) ； 洪仁宇(Jen-Yu Hung)

《內科學誌》 34卷5期 (2023/10) Pp. 380-388

https://doi.org/10.6314/JIMT.202310_34(5).07

摘要

當電子煙（E-cigarette）於2007年在美國推出之後，因其號稱可減少尼古丁以及致癌物質如焦油之吸入，而迅速地在大眾尤其是在年輕族群中受到歡迎。但隨著電子煙的流行和使用增多，研究發現使用電子煙有許多潛在的併發症，其中使用電子煙或相關產品導致的肺損傷（e-cigarette or vaping product use-associated lung injury, EVALI）近來被大量報導。其明確的病理機制尚待確定，並且可能有多種的致病機轉參與其中。臨床表現較無特異性，影像以雙下肺葉實質病變及毛玻璃病變為主。EVALI為排除性診斷，需有使用電子煙的歷史、胸部影像的病灶，並排除其他感染症和其他可解釋之原因。治療上主要為支持性療法，通常EVALI對於類固醇治療有良好的反應。一般而言EVALI臨床表現廣泛，而嚴重者可產生急性呼吸窘迫症與呼吸衰竭甚至死亡，好發在年輕族群，但是否會留下長期後遺症目前尚不清楚。

關鍵字

電子煙（E-cigarette） ； 肺損傷（lung injury） ； 四氫大麻酚（tetrahydrocannabinol, THC） ； 維生素E醋酸鹽（Vitamin E acetate） ； 類固醇（Steroid）

並列摘要

E-cigarettes were launched in the United States in 2007. E-cigarettes quickly became popular among the general public, especially the young people because e-cigarettes were claimed to reduce the intake of carcinogens, such as nicotine and tar. However, with the diversification of devices and e-liquids, more and more complications, such as e-cigarette or vaping product use-associated lung injury (EVALI) have been reported. The underlying pathogenesis of lung injury remains to be determined and a variety of pathological mechanisms may be involved. The clinical manifestations are relatively non-specific. The radiographical findings mainly consist of bilateral lower lobe parenchymal lesions and ground glass lesions. EVALI is a diagnosis of exclusion. Its diagnosis was made based on a history of e-cigarette use, patterns on chest imagings, and exclusion of other infectious diseases and other possible causes. Treatment is mainly supportive. Although lacking of enough evidence, EVALI generally responds well to steroid treatments. The prognosis of EVALI is good, especially in the young population. Whether EVALI causes long-term sequelae or not is still unknown.