隐源性机化性肺炎误诊16例临床分析

Clinical Analysis of 16 Cases of Misdiagnosed Cryptogenic Organizing Pneumonia

目的探讨隐源性机化性肺炎(cryptogenic organizing pneumonia,COP)的临床特点、治疗方法、误诊原因及防范措施。方法对曾误诊为社区获得性肺炎(community acquired pneumonia,CAP)的16例COP的临床资料进行回顾性分析。结果本组误诊率为61. 5%。以咳嗽伴呼吸困难及乏力就诊3例,咳嗽伴发热就诊3例,咳嗽、发热伴乏力就诊3例,单纯发热、单纯咳嗽及单纯胸痛就诊各2例,咳嗽伴胸痛及乏力就诊1例。9例肺部可闻及湿啰音,1例肺部可闻及Velcro啰音。实验室检查以血白细胞、中性粒细胞及C反应蛋白升高为主。胸部CT检查以斑片、实变及磨玻璃影为主。就诊初期皆误诊为CAP。误诊时间4~25(12. 0±5. 6)d。按误诊疾病给予相应治疗效果不佳。后均经病理检查确诊COP。给予糖皮质激素治疗,除1例失访外,余15例均预后良好。结论 COP临床表现和胸部CT检查缺乏特异性,易误诊。认真病史询问、仔细鉴别诊断和及时进行相关检查可减少或避免COP误诊误治。

Objective This study aims to explore the clinical characteristics, the treatment, causes of misdiagnosis and preventive measures of the cryptogenic organizing pneumonia （COP）. Methods We conducted a retrospective analysis of the clinical data of 16 cases COP which had been misdiagnosed as community acquired pneumonia （CAP）. Results The misdiagnosis rate was 61.5% in this group. There were 3 COP patients who presented to our hospital for cough associated with dyspnea and fatigue, 3 for cough associated with fever, 3 for cough associated with fever and fatigue, 2 for fever, 2 for cough, 2 for chest pain and 1 for cough associated with chest pain and fatigue. Moist rales were heard in 9 cases and velcro rales were heard in one. The laboratory tests results showed that the numbers of white blood cells and neutrophils as well as c-reactive protein were increased significantly in these patients. The chest CT scan revealed exudation at different patches and solid shadow. At initial visit to our hospital, they were all misdiagnosed as CAP, and the duration of misdiagnosis was 4-25 （12.0±5.6）d. Because of the misdiagnosis, the corresponding treatment effect was far from satisfactory. When COP was confirmed by pathological examination, they were treated with glucocorticoid. The prognosis of the remaining 15 patients was good except 1 who was lost to follow-up. Conclusion COP is more likely to be misdiagnosed by chest CT scan due to lack of specificity of clinical characteristics. Careful inquiry of medical history and differential diagnosis as well as prompt examination can reduce or avoid the misdiagnosis and treatment of COP.