隐原性机化性肺炎的CT影像学特征及激素治疗后的改变

Cryptogenic organizing pneumonia:CT features and the effect of glucocorticoids

目的了解隐原性机化性肺炎(COP)治疗后 CT 影像学的变化。方法回顾分析我院2001至2005年有临床表现、实验室检查、经病理活检证实、影像学表现支持的 COP 患者21例,男2例,女19例,平均年龄39～74岁。追踪检查85次,平均4次,最多8次;最短复查间隔时间为5 d,最长2.5个月;随访最短时间为3个月,最长43个月。结果 CT 表现为多发性斑片状、含气实变影,主要分布在胸膜下区和双肺下叶。多数伴有磨玻璃影、小支气管扩张及条索状影。部分有病灶游走的表现。肾上腺皮质激素治疗21例,20例有显著疗效,治疗后病灶完全吸收4例,大部分吸收16例,无明显变化1例,治疗后出现反复2例。结论 COP 应结合临床表现、影像学、病理检查综合诊断,治疗中 CT 追踪检查有利于了解治疗效果。

Objective To study the CT manifestations of cryptogenic organizing pneumonia （COP） after glucocorticoid treatment. Methods The diagnosis of COP was made based on clinical and radiological features and comfirmed by lung biopsy and pathological examination in 21 cases from 2001 to 2005. CT follow-up was carried out 5 -75 days following therapy. The follow-up lasted 3 -43 months. All data were analyzed and relevant literatures were reviewed. Results There were 2 male an 19 female patients with ages of 39 -74 years. CT scans revealed multiple patchy shadows or patchy air-space consolidations, often by a predominantly subpleural and/ or basal distribution. Ground-glass opacities and bronchioectasis were common findings. Migratory lesions were found in some patients. Glucocorticoid treatment resulted in significant improvement in most cases. Cure was achieved in 4 cases, significant improvement in 16 , and failure in 1 case. Recurrence was found in 2 cases. Conclusions The diagnosis of COP requires combination of clinical, CT and pathological manifestations. The effect of glucocorticoid therapy can be evaluated by repeated CT scanning.