38例隐源性机化性肺炎临床特征分析

The Clinical Analysis of 38 Patients with Cryptogenic Organizing Pneumonia

目的分析隐源性机化性肺炎(COP)患者的临床特征,以提高对该疾病的认识及诊治水平。方法回顾性分析郑州大学第一附属医院2014年4月至2019年10月收治的38例COP患者的临床症状及体征、实验室检查、肺功能检查、影像学检查、治疗与转归。结果38例COP患者中,男21例(55.3%),女17例(44.7%),年龄19~81岁,平均(57.68±13.64)岁。咳嗽(92.1%)、咳痰(78.9%)、发热(55.3%)及胸闷(55.3%)为常见症状,2例(5.3%)患者出现咯血。实验室检查发现出现红细胞沉降率升高(65.8%),C反应蛋白升高(60.5%)及纤维蛋白原升高(63.2%)。绝大多数肺功能呈轻中度限制性通气功能障碍伴弥散功能障碍。胸部CT表现多样且缺乏特异性,双肺多发斑片状高密度影较为常见(79.0%),可见结节样改变(10.5%)、磨玻璃样改变(7.9%)及蜂窝状改变(2.6%)、支气管充气征(26.3%)及反晕征(13.1%),较为特殊的是出现3例孤立团块样病变,初期与肺癌难以鉴别。主要病理特征为肺间质纤维组织及肺泡上皮增生,肺泡间隔增厚,可伴局灶肉芽肿性炎,周围见淋巴细胞等炎症细胞浸润。37例患者口服糖皮质激素治疗,其中3例患者同时口服克拉霉素,辅以化痰、止咳、退热、营养等对症支持治疗,1例因症状较轻未应用糖皮质激素治疗,仅接受对症治疗。随访有4例患者出现复发,余患者好转。结论COP起病隐匿,男女发病率无明显差异,实验室检查及影像学检查缺乏特异性,明确诊断有赖于组织病理学检查,绝大多数对糖皮质激素治疗反应良好,预后佳,但容易复发,故认识其临床特征有助于鉴别其他相关疾病,提高对该病的诊治水平。

Objective To analyze the clinical features of patients with cryptogenic organizing pneumonia(COP),and to improve the understanding of the disease and the level of the diagnosis and treatment.Methods The clinical features,laboratory tests,lung function,imaging manifestations and treatment of 38 patients with COP were retrospectively analyzed,who were admitted to the First Affiliated Hospital of Zhengzhou University from April 2014 to October 2019.Results Among the 38 patients,21 were male(55.3%)and 17 were female(44.7%),aged 19-81 years,with an average age of(57.68±13.64)years.Cough(92.1%),sputum(78.9%),fever(55.3%)and chest tightness(55.3%)were the most common symptoms in those patients,and 2(5.3%)patients developed hemoptysis.Laboratory examinations found that most patients had erythrocyte sedimentation rate(65.8%),C-reactive protein(60.5%),and fibrinogen(63.2%)elevated.The majority of pulmonary function testing showed mild to moderate restrictive defect with diffuse impairment.Chest CT manifestations were diverse and lack specificity.Multiple patchy high-density shadows of both lungs were more common(79.0%),with nodular changes(10.5%),ground glass changes(7.9%),and honeycomb changes(2.6%),bronchial inflation sign(26.3%)and anti-halo sign(13.1%)were also visible.More particularly,there were 3 cases of isolated mass-like lesions,and it was easily misdiagnosed as lung carcinoma at the initial stage.The main pathological features were pulmonary interstitial fibrous tissue and alveolar epithelial hyperplasia,alveolar septum thickening,which may be accompanied by focal granulomatous inflammation,lymphocytes and other inflammatory cells infiltrate around.A total of 37 patients were treated with oral glucocorticoids,of which 3 patients took clarithromycin at the same time,supplemented with symptomatic and supportive treatments such as phlegm,cough relieving,fever,nutrition,etc.One case did not use glucocorticoids due to mild symptoms treatment,only symptomatic treatment.During follow-up,4 patients relapsed,and the rest improved.Conclusion The onset of COP is concealed.There is no difference in the prevalence of male and female.The laboratory and imaging tests lack specificity.Definite diagnosis depends on histopathological examination.The vast majority of patients respond well to glucocorticoid therapy.The prognosis is well,but it is easy to relapse,so understanding its clinical features helps to distinguish other related diseases and improve the diagnosis and treatment of the disease.