急性纤维素性机化性肺炎2例报道及文献复习

Acute fibrinous and organizing pneumonia:A report of 2 cases and literature review

目的总结分析急性纤维素性机化性肺炎(AFOP)的临床表现及病理组织学特点。方法分析2例经病理证实的AFOP患者临床资料、诊治经过并复习相关文献。结果 2例患者均为男性(年龄47岁、45岁),临床表现为发热、咳嗽、呼吸困难。1例胸部CT示右肺中叶大叶性肺炎,经多种抗生素治疗无效;1例胸部CT示右肺上叶团片状实变影,抗感染治疗曾有改善,但短时间内症状再次加重。分别行经皮穿刺肺活检及电子支气管镜肺活检,病理表现为肺泡腔内纤维素样沉积物,部分形成纤维素样球,形态学符合AFOP改变。2例患者经糖皮质激素治疗后症状均很快缓解,影像学检查见肺部病变吸收。1例治疗3个月后停药,1例正在激素减量治疗中。结论 AFOP有独特的病理表现,但临床表现缺乏特异性,易被误诊为肺炎。AFOP能否作为独立的疾病诊断,目前尚存争议。

Objective To summarize and analyze the clinical and pathological characteristics of acute fibrinous and organizing pneumonia （AFOP）. Methods The clinical data and the process of diagnosis and treatments of 2 patients diagnosed as AFOP were analyzed, combined with related literature review. Results The main clinical manifestations of the 2 patients （both males, aged 47 and 45 years respectively） were fever, cough, and dyspnea. The chest CT in one patient revealed lobar pneumonia in the right middle lobe of lung, and failed of antibiotic therapy. In another case, the chest CT revealed consolidation in the right upper lobe of lung, and the condition was improved initially by antibiotic therapy, but the symptoms aggravated again in a short time. Computed tomography guided percutaneous lung biopsy and transbronchial lung biopsy revealed the presence of intra-alveolar cellulose-like sediments, parts of which formed cellulose-like ＂balls＂, which were consistent of AFOP. The two patients showed clinical and radiological improvement after glucocorticoid therapy. One patient was treated with glucocorticoid for 3 months, and the other one was still on a tapering dose of steroids. Conclusions AFOP presents unique pathologic features, but no specific clinical features, patients with AFOP are easily misdiagnosed as pneumonia. Whether AFOP is an independent disease diagnosis is still a controversy.