急性纤维素性机化性肺炎五例临床和影像及病理分析

The clinicopathological features of acute fibrinous and organizing pneumonia

目的观察急性纤维素性机化性肺炎的临床、影像学及病理特点，以提高临床医生对该病的认识。方法回顾性分析南京市鼓楼医院2011年3月至2012年6月通过CT引导下经皮肺穿刺活检确诊的5例急性纤维素性机化性肺炎患者的临床资料，总结其临床、影像学及病理特征。结果5例患者中男2例，女3例，年龄43～61岁，均表现为亚急性起病，主要的临床症状为呼吸困难、咳嗽、咳痰、发热、胸痛，血气分析为低氧血症。胸部高分辨率CT主要表现为双肺弥漫性、斑片状分布的浸润影。主要病理表现为肺泡间隔略增宽，可见淋巴细胞和浆细胞浸润，肺泡腔内可见纤维母细胞呈息肉状延伸（机化）伴纤维素样红染物质，未见中性粒细胞和嗜酸粒细胞浸润，病理上不同于其他已确定的急性肺损伤，如弥漫性肺泡损伤、隐源性机化性肺炎及嗜酸粒细胞性肺炎。所有病例经糖皮质激素治疗后症状很快缓解，胸部影像学改变明显好转。结论急性纤维素性机化性肺炎临床表现缺乏特异性，诊断主要依赖组织病理学检查，对糖皮质激素治疗反应良好。但其是否为一种独立的问质性疾病有待进一步临床验证。

Objective To improve understanding of the clinical, radiological and pathological characteristics of acute fibrinous and organizing pneumonia （AFOP）. Methods The clinical data of 5 AFOP patients were retrospectively analyzed. AFOP was diagnosed via percutaneous lung biopsy guided by chest computerized tomography （CT） in the Affiliated Drum Tower Hospital of Nanjing University Medical School during March 2011 to June 2012. The clinical, radiological and pathological characteristics of those patients were summarized. Results Among the 5 patients, 2 were male and 3 were female, aging 43 -61 years. They were all subaeute onset. The main clinical manifestations were dyspnea, productive cough, fever and chest pain with hypoxemia via blood gas analysis. Bilateral infiltrates with diffuse and pathy distribution were the predominant features in chest HRCT. The pathological examination revealed slightly widened alveolar septa, 1 ymphocyte and plasma cell infiltration and the presence of intra-alveolar fibrin in the form of fibrin ＂balls＂ （organization） within the alveolar spaces. No neutrophil, and eosinophil infiltration and hyaline membrane formation were detected, which was different from other well-recognized histologic patterns of acute lung injury, such as diffuse alveolar damage, cryptogenic organizing pneumonia and eosinophilic pneumonia. All patients were treated by corticosteroids and showed significant clinical and radiological improvement. Conclusions AFOP has nospeeific features, and its diagnosis depends on pathological examination. Treatment with cortieosteroids is optimal. However, whether it is a unique interstitial disease needs to be further clinically investigated.