20例隐源性机化性肺炎的影像特点分析

An Analysis of Manifestations in 20 cases of Cryptogenic Organizing Pneumonia

目的探讨隐源性机化性肺炎的临床表现、影像学特征、病理特征,以提高对该病的认识及诊断水平。方法选取我院2010年1月-2017年6月收治的20例隐源性机化性肺炎病人的高分辨CT检查报告作为研究对象,对照患者病理学检查结果,跟踪调查患者的治疗结果,进行综合分析。结果隐源性机化性肺炎多见于40岁以上的女性病人,主要表现为咳嗽、咳痰,活动后喘憋、气促等临床症状。隐源性机化性肺炎的HRCT表现为18例双肺病变,其中11例为多灶性实变,3例为磨玻璃密度影,另4例为多结节影;肺功能弥散受限,血常规大部分白细胞增高,CRP升高,病理提示机化性肺炎。采用抗感染治疗无明显效果,应用激素类药物治疗效果显著,其中糖皮质激素的作用率为100%。所有患者随访1-2年病情稳定。结论隐源性机化性肺炎具有一定的影像学特征,典型CT特点表现为实变、多灶性、结节,双肺分布,以及胸膜下与支气管血管束旁分布等影像特征性表现;通过典型影像学表现,经支气管镜灌洗液或经CT引导下经皮肺穿刺活检病理学检查可确诊,部分患者仍需要通过胸腔镜检活检进行确诊。

Objective To investigate the clinical features, imaging features and pathological features of cryptogenic organizing pneumonia, so as to improve the understanding and diagnostic level of this disease. Methods A total of 20 patients with cryptogenic organizing pneumonia treated from January 2010 to January 2017 in our hospital were selected. The clinical results based on the high resolution CT(HRCT) and pathological examination were compared and comprehensive analysis was conducted. Results The cryptogenic organizing pneumonia was commonly seen for the female patients aged over 40;the major clinical symptoms included cough, expectoration, asthma after the physical exercises, anhelation, etc. According to the HRCT manifestations, there were 18 cases of bilateral pulmonary disease, among them, 11 cases were multifocal solid degeneration, 3 were glass opacity and 4 were multiple nodules. Pulmonary function diffusion limited, most of the white blood cells increased, CRP increased. The antibiotic therapy was not effective. The hormone drugs were effective, for instance, the clinical effective rate of glucocorticoid was 100%. Within 1-2 y of follow-up visits, the patient’s disease was stably controlled. Conclusion For patients with cryptogenic organizing pneumonia, the typical CT manifestations include the distributions of consolidation, multiple lesions and bilateral lesions, subpleural distribution and broncho-vascular distribution, etc. According to the typical imaging manifestations, transbronchial lung lavage or CT guided percutaneous biopsy of the lung can be confirmed by pathological examination while some of the patients have to be confirmed through the open-lung biopsy.