摘要
目的:探讨隐源性机化性肺炎(COP)的临床和影像学特征,提高临床诊断和治疗的水平。方法:回顾性分析我院2011年3月至2018年1月,确诊的16例COP的一般资料、临床表现、常规实验室检查、影像学特征、肺活检病理及治疗与转归。结果:16例患者中,男性9例,女性7例,男女比例为1.29∶1,年龄45~84岁,平均年龄(60.7±11.1)岁,从发病到确诊时间10d至7个月,中位确诊时间28(20,69)d,8例有主动吸烟或者被动吸烟史。所有患者均有呼吸道症状,发生率前3位的为咳嗽15例,咯痰11例,发热8例,胸部查体主要为病变部位的湿罗音。相对于白细胞正常或者轻度升高,C反应蛋白和血沉升高较明显。肺功能显示50%患者存在弥散功能和阻塞性通气功能障碍。胸部CT主要为磨玻璃影和实变影为主,分布以胸膜下和双下肺为主。6例经皮穿刺肺活检,5例经胸腔镜肺活检以及5例经纤支镜肺活检和支气管肺泡灌洗明确诊断,除5例患者行肺叶切除术,余11例行激素治疗,3例有复发,加量激素,延长疗程后,病情好转。结论:临床表现和胸部影像学特征对COP有提示作用,确诊需要病理,经皮肺穿刺或者经支气管镜肺活检结合支气管肺泡灌洗对临床确诊COP有较高价值。绝大多数COP对激素反应良好,此病预后良好。
Objective: To analyze the characteristics of pathologically diagnosed cryptogenic organizing pneumonia( COP) including clinical and imaging features to improve the diagnosis and treatment of this disease. Methods: General profile,clinical manifestations,routine laboratory tests,imaging features,pathological result of lung biopsy,treatment and prognosis of 16 patients diagnosed as COP from March 2011 to January2018 in Beijing Anzhen Hospital with were retrospectively reviewed. Results: 16 patients [9 male and 7 female,gender ratio is 1. 29∶ 1,aged from 45-84,( 60. 7 ± 11) years old] were diagnosed as COP. The median time from symptoms onset to COP diagnosis was 28( 20,69) days,varying from 10 days to 7 months. 8 patients had smoking or passive smoking history. All patients had respiratory symptoms,with 13 cough,11 expectoration and 8 fever. Major abnormal feature on chest physical examination is wet rales in lesions. CRP and ESR were evaluated a lot in these patients while WBC is normal or slightly increased. It showed that half of patients suffered from obstructive ventilatory disturbance and impaired diffuse capacity on spirometry test. Major manifestations were ground glass opacity and consolidation on chest CT which were located in subpleural area and bilateral lower lobe. 6 patients were diagnosed by percutaneous aspiration lung biopsy,5 by video assisted thoracic surgery and 5 by transbronchial lung biopsy plus bronchoalveolar lavage. 11 patents were treated with glucocorticoid. There were 3 recurrence with follow up who had gained medical improvement by increasing dose of glucocorticoid and prolonging the period of treatment. Other 5 patients were underwent pulmonary lobectomy with no recurrence with follow up. Conclusion: Clinical manifestations and radiological features were predictive for the diagnosis of COP. The diagnosis requires pathological result mainly from percutaneous aspiration lung biopsy and transbronchial lung biopsy with bronchoalveolar lavage. Most patients treated with glucocorticoid were improved well and had a favorable prognosis
作者
王增智
李栋
李杰
高杨
张向峰
刘双
WANG Zengzhi;LI Dong;LI Jie;GAO Yang;ZHANG Xiangfeng;LIU Shuang(Department of Respiratory and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
2018年第7期623-628,共6页
Journal of Cardiovascular and Pulmonary Diseases
关键词
机化性肺炎
隐源性机化性肺炎
胸部CT
Organizing pneumonia
Cryptogenie organizing pneumonia
Chest CT