20例隐源性机化性肺炎的临床分析

Clinical Analysis of 20 Cases of Cryptogenic Organizing Pneumonia

目的:分析隐源性机化性肺炎(COP)患者的临床表现、影像改变、实验室检查结果及治疗转归,以提高对COP的认识。方法:回顾性分析2007年11月到2012年11月在上海交通大学附属第一人民医院、湖州市中心医院经病理诊断为COP患者20例。对临床表现、影像特征、实验室检查结果及治疗转归,进行统计学处理和分析。结果:COP患者平均年龄(55±16)岁,主要症状是咳嗽,咳痰,发热。肺部听诊可有湿口罗音。最常见的病灶形态为斑片实变影,其次为肿块/结节影。多数患者白细胞计数正常,中性粒细胞比例升高,C反应蛋白、血沉升高。肺功能可正常或呈限制性、阻塞性、混合性通气功能障碍。COP患者对抗生素治疗无反应,对激素治疗反应良好,1年内17.6%患者复发。结论:COP的临床表现、影像改变、辅助检查结果不具特征性。通过肺活检方法取得组织病理是确诊的关键。提高对本病的认识,有助于避免抗生素的不合理使用。

[Objective]To improve the knowledge of cryptogenic organizing pneumonia（COP）through analyzing the clinical manifestations,radiological features,laboratory results,treatment and outcome from COP patients.[Method]20 cases of COP confirmed by pathology in Shanghai First People＇s Hospital of Shanghai Jiao Tong University and Huzhou Central Hospital from November 2007 to November 2012 were retrospectively reviewed.The clinical manifestations,radiological features,laboratory results,treatment and outcome were collected and statistically analyzed.[Result]The mean age of COP patients was 55±16 years,the main symptoms include cough,expectoration and fever.Crackles at auscultation could be found.Patchy consolidation was the most common lesion,mass/nodule was less common lesion.The white cell count was normal,while the percentage of neutrophils increased in most patients.C-reactive protein and erythrocyte sedimentation rate were also increased.Pulmonary function could be normal,restrictive,obstructive or mixed pattern.COP patients responded poorly to antibiotics but responded well to steroid therapy.17.6% patients had relapse within one year.[Conclusion]Since the clinical manifestations,radiological changes and accessory examination from COP were unspecific.The tissue pathology through lung biopsy is the key for diagnosis.Strengthen the recognition of COP would avoid the irrational use of antibiotics.