隐源性机化性肺炎30例临床特征分析

Clinical features analysis of 30 cases of cryptogenic organizing pneumonia

目的分析隐源性机化性肺炎患者的临床特点,以提高该病的临床诊疗水平,降低漏诊、误诊的发生。方法回顾性分析首都医科大学附属北京朝阳医院于2018年1月至2018年12月确诊的隐源性机化性肺炎30例,收集患者的临床资料,对临床表现、实验室检查、影像学特征、病理学检查、治疗及预后情况进行分析。结果30例隐源性机化性肺炎患者的呼吸道症状包括咳嗽21例(70.0%)、咯痰19例(63.3%)、发热13例(43.3%)、呼吸困难11例(36.7%)。所有患者白细胞正常或者轻度升高,C反应蛋白和红细胞沉降率升高较明显。胸部CT主要表现为斑片、网格、磨玻璃影。24例经纤维支气管镜肺活检和支气管肺泡灌洗确诊,6例通过经皮穿刺肺活检确诊。25例行激素治疗,5例轻症患者予阿奇霉素治疗,病情均好转,无复发。结论隐源性机化性肺炎的临床表现和影像学缺乏特异性,需结合肺活检确诊。该病对激素敏感,及时治疗预后良好。

Objective To analyze the characteristics of cryptogenic organizing pneumonia(COP)to improve the diagnosis and treatment of this disease.Method Clinical manifestations,routine laboratory tests,imaging features,pathological result of lung biopsy,treatment and prognosis of 30 patients diagnosed as COP from January 2018 to December 2018 in Beijing Chaoyang Hospital were retrospectively reviewed.Result There were 21 cases(70.0%)of cough,19 cases(63.3%)of sputum,13 cases(43.3%)of fever and 11 cases(36.7%)of dyspnea.White blood cells were normal or slightly elevated,while C-reactive protein and erythrocyte sedimentation rate were significantly elevated.Chest CT mainly includes patch,mesh and ground glass.24 cases were confirmed by bronchoscopy lung biopsy and bronchoalveolar lavage,and 6 cases were confirmed by percutaneous puncture lung biopsy.25 patients received hormone therapy and 5 patients with mild disease were treated with azithromycin.Conclusion The clinical manifestations and imaging features of COP are not specific,which can be confirmed by combining with lung biopsy.COP is sensitive to hormones and has a good prognosis after timely treatment.