隐源性机化性肺炎与继发性机化性肺炎的诊治特点及预后比较

Comparison of clinical diagnosis, treatment and prognosis between cryptogenic organizing pneumonia and secondary organizing pneumonia

目的比较隐源性机化性肺炎(COP)与继发性机化性肺炎(SOP)的诊治特点及预后。方法收集经病理检查确诊的机化性肺炎患者38例,其中COP 17例(COP组),SOP 21例(SOP组),比较两组患者的临床表现、实验室指标、肺泡灌洗液细胞学计数、肺功能、影像学特点、治疗及预后。结果两组患者大部分临床表现、实验室指标、肺泡灌洗液细胞学计数、肺功能等方面比较差异均无统计学意义(均P>0.05)。SOP组患者肺部湿啰音、Velcro啰音、多肺叶病灶和下肺病灶检出率均高于COP组,多发斑片状实变影检出率、治疗有效率均低于COP组,激素总剂量高于COP组,治疗总疗程长于COP组,差异均有统计学意义(均P<0.05)。结论 SOP与COP在影像学表现上存在一定差异,SOP预后较差,复发率高,部分患者需要激素联合免疫抑制剂治疗;克拉霉素可作为COP治疗的一种选择。

Objective To investigate the clinical diagnosis, treatment and prognosis of cryptogenic organizing pneumonia (COP) and secondary organizing pneumonia(SOP). Methods Clinical data of 38 patients with pathologically confirmed organizing pneumonia, including 17 cases of COP and 21 cases of SOP, were retrospectively analyzed. The clinical manifestations, laboratory test, lung function, alveolar lavage fluid, imaging features, treatment and prognosis were compared between the two groups. Results The connective tissue diseases related organizing pneumonia(CTD-OP) was the most common in SOP, followed by OP secondary to infection. There were no significant differences in clinical symptoms, laboratory tests and pulmonary function between the two groups(all P >0.05). The incidence of wet rales and Velcro rales in SOP was higher than that in COP group(both P<0.05). Compared with the COP group, the SOP group was more prone to present with multiple patchy alveolar opacities in the lower lobes(P<0.05). In addition, SOP group had longer duration of treatment, lower effective rate and higher dosage of glucocorticoid(all P<0.05). Conclusion There are differences in imaging performance between SOP and COP. SOP has a poor prognosis and high recurrence rate. Some patients need glucocorticoid combined with immunosuppressive therapy. Clarithromycin can be used as an alternative option for COP treatment.