闭塞性细支气管炎伴机化性肺炎的临床表现与HRCT特点

Clinical Manifestation and HRCT Features of Bronchiolitis Obliterans with Organizing Pneumonia

目的:探讨闭塞性细支气管炎伴机化性肺炎(BOOP)的临床表现及高分辨率CT(HRCT)特点,提高对该病的认识。材料和方法:回顾性分析16例经病理证实并行HRCT检查的BOOP患者资料,分析其临床表现、肺功能结果、X线胸片及HRCT特点。结果:14例患者主要表现为干咳和(或)气短,2例主要表现发热伴咳嗽。12例患者肺功能检查表现为限制性通气功能障碍和(或)弥散功能减低,4例肺功能正常。12例患者X线胸片呈多发斑片实变影,4例表现为纹理增粗。16例患者HRCT扫描表现为多发斑片实变影和(或)磨玻璃影,4例伴小结节。1例病变弥漫分布于双肺,15例病变位于胸膜下和(或)沿支气管血管束分布。肾上腺皮质激素治疗16例患者有效。结论:BOOP主要的临床特征是干咳、气短。HRCT对该病的早期诊断具有重要价值,可提示活检部位,随访激素治疗效果。最终确诊依赖于临床-放射-病理诊断。

Purpose To explore the clinical manifestation and imaging findings of high resolution computed tomography （HRCT） of bronchiolitis obliterans with organizing pneumonia（BOOP）. Materials and Methods The clinical manifestations,pulmonary function,chest X-ray films and HRCT findings of 16 patients with BOOP confirmed by pathology were analyzed retrospectively. Results The main clinical manifestations were dry cough and/or shortness of breath in 14 patients,fever and cough in 2 patients. Pulmonary function tests showed restrictive ventilation disturbance and/or a decreased diffusing capacity in 12 patients and normal condition in 4 patients. Chest X-ray films showed multiple patchy consolidation in 12 patients and thickening of lung markings in 4 patients. HRCT scans demonstrated patchy consolidation and/or ground-glass opacity in 16 patients and fine nodular consolidation in 4 patients. The lesions were diffuse in 1 patient and had a predominantly subpleural and/or peribronchovascular distribution in 15 patients. Corticosteroid therapy was effective in 16 patients. Conclusion The main clinical manifestations of BOOP are dry cough,shortness of breath. HRCT scans are valuable in the early diagnosis,follow-up and selection of biopsy location of BOOP. The final diagnosis relies on the combination of clinical manifestation,radiologic finding and pathologic confirmation.