42例隐源性机化性肺炎临床分析及诊治思考

Clinical analysis of 42 cases of cryptogenic organizing pneumonia

目的:分析隐源性机化性肺炎(COP)的临床特点,提高基层住院医师对隐源性机化性肺炎的认识及诊治的水平。方法:收集2012年3月1日至2019年3月31日7年期间在赣南医学院第一附属医院住院、经确诊为隐源性机化性肺炎患者的临床资料,回顾性分析其症状及体征、实验室检验及影像学资料等。结果:符合纳入标准的42例患者中男28例,女14例,平均年龄(60.43±15.05)岁。患者多数亚急性起病,症状以咳嗽、咳痰最为多见,其次为不同程度的呼吸困难及低热,还有部分患者有痰中带血、胸痛、乏力等症状,半数以上患者可闻及不同程度湿性啰音或少许Velcro啰音。胸部CT表现为肺内多发斑片状影、结节影、条索影、网格影等,病变多分布于两肺外周及胸膜下,部分伴有纵隔淋巴结肿大、胸腔积液、胸膜增厚等。40例患者接受糖皮质激素治疗,1例予抗结核治疗,1例未予激素及大环内酯类等药物治疗,大多数患者临床症状缓解,1例复发。结论:COP极易误诊为肺部感染,结合临床表现、辅助检查及影像学特征能有效诊治COP,确诊还需肺活检病理学依据支持,同时需要排除明确的致病原和结缔组织疾病继发性改变等可能。

Objective:To analyze the clinical characteristics of cryptogenic organizing pneumonia(COP)and to improve the understanding and diagnosis of cryptogenic organizing pneumonia among grassroots residents.Methods:Collecting clinical data of patients with cryptogenic organizing pneumonia who were hospitalized in the First Affiliated Hospital of Gannan Medical University from March 1,2012 to March 31,2019,and retrospective analysis of symptoms and signs,laboratory tests and imaging data,etc.were made.Results:Of the 42 patients who met the inclusion criteria,28 were male and 14 were female,with an average age of(60.43±15.05)years.Most of the patients have sub-acute onset,the most common symptoms were cough and sputum,followed by varying degrees of difficulty breathing and low fever,and some patients had symptoms such as blood in sputum,chest pain and fatigue.More than half of the patients could hear the different degrees of moist rales or a little Velcro voice.Chest CT showed multiple patchy shadows,nodular shadows,strips,and mesh shadows in the lungs.The lesions were mostly distributed in the peripheral and sub pleural layers of the lungs,and some were associated with mediastina lymphadenopathy,pleural effusion and pleural thickening so on.Forty patients received glucocorticoid therapy,one received anti-tuberculosis treatment,and one patient was not treated with hormones and macrolides.Most patients had clinical symptoms and one patient had recurrence.Conclusion:COP is easily misdiagnosed as pneumonia.Combined with clinical manifestations,auxiliary examination and imaging features,we can effectively diagnose and treat COP.The diagnosis requires the support of pathological basis of lung biopsy,and it is necessary to exclude specific pathogens or pulmonary infection and Secondary changes in connective tissue diseases.