隐源性机化性肺炎9例临床分析

Clinical analysis of 9 patients with cryptogenic organized pneumonia

目的探讨隐源性机化性肺炎(cryptogenic organized pneumonia,COP)的临床、病理和影像学特征以及治疗。方法回顾性分析9例COP患者的临床、病理、影像学特点及其治疗转归。结果患者多有咳嗽、呼吸困难等症状,体检多可闻及湿啰音,少数呈爆裂音;实验室检查示外周血白细胞、C-反应蛋白、血沉异常,肺功能示限制性通气功能障碍和(或)弥散功能障碍。胸部HRCT主要表现为实变影。所有患者均由肺部病灶病理确诊,经糖皮质激素治疗好转,随访3月至12月,病情控制良好。结论 COP临床表现缺乏特异性,易误诊为肺部感染或肿瘤,抗感染治疗效果差,而糖皮质激素治疗有效,应及早获得病理学证据指导诊疗。

Objective To explore the clinical manifestation, CT characteristics, pathological features and the treatment strategy of cryptogenic organized pneumonia （COP）. Methods The clinical features of 9 patients diagnosed as COP with pathological evidences were retrospectively investigated. Results Persistent nonproductive cough, expiratory dyspnea, fever and pulmonary rales （ sometimes Velcro） were the most common symptoms among these patients. The level of peripheral blood WBC number, C-reactive protein, and e- rythrocyte sedimentation increased obviously. Pulmonary function revealed the restrictive ventilatory disfunction with or without diffusion abnormalities. The main expression of chest through HRCT was opacity. All the patients got pathological evidences, and all of them were cured after corticosteroids therapy. Their conditions remained stable during a follow-up of 3 to 12 months. Conclusions The clinical manifestation of COP has no clear specificity, thus it could be easy to be misdiagnosed as lung infection or tumor. The effects of ordinary anti-bacteria therapy are limited, while the corticosteroids therapy shows preferable effects. Therefore, it＇s important to acquire pathologi- cal evidences as early as possible to guide the diagnose and treatment.