51例非感染性肺空洞疾病的临床分析

Clinical analysis of 51 cases of non-infectious pulmonary cavity disease

目的探讨非感染性肺空洞疾病的临床特点,以便拓宽诊断思路,减少误诊,误治,提高诊断水平。方法回顾性分析我院2010年1月至2020年11月收治的经病理组织证实、实验室检查确诊的51例非感染性肺空洞疾病患者的临床资料,其中肿瘤性空洞32例为肿瘤组,非肿瘤性空洞19例为非肿瘤组。结果非感染性肺空洞疾病特点是男性、中老年发病为主,亚急性、慢性病程,咳嗽、咳痰、咯血等呼吸道症状常见,部分患者有发热,肿瘤组与非肿瘤组在血常规、中性粒细胞百分比、C-反应蛋白比较上无统计学差异(P>0.05)。两组误诊率为46.7%、63.2%。肿瘤组吸烟人数、日吸烟量、病史时间明显高于非肿瘤组,肿瘤标记物多为阳性,肿瘤组空洞内壁凹凸不平、洞壁强化、外形分叶、边缘毛刺、纵隔淋巴结肿大的患者数明显高于非肿瘤组(P<0.05)。非肿瘤组抗中性粒细胞胞浆抗体(CANCA)阳性、血清IgG4升高为特异性化验,多因素Logistic回归分析显示吸烟史、有纵隔淋巴结肿大是确诊肿瘤性肺空洞疾病的独立危险因素,伴肺内其他病变、复查肺部影像有变化是确诊非肿瘤性非感染性肺空洞疾病的独立危险因素。结论非感染性肺空洞疾病病因以肿瘤性居多,影像部分有恶性肿瘤的共性,特征不明显时易误诊为感染性疾病;非肿瘤性临床少见,病因复杂,肺部空洞可以是其疾病发展的过程,结合临床、动态观察,可减少误诊,最终确诊需病理证实。

Objective To broaden the diagnostic strategy,reduce misdiagnosis and mistreatment,and improve the diagnostic level by exploring the clinical characteristics of non-infectious pulmonary cavity diseases.Methods It was analyzed retrospectively that the clinical data of 51 patients with non-infectious pulmonary cavity disease admitted to our hospital from January 2010 to November 2020.The diagnosis of all these cases was confirmed by pathological tissue and laboratory tests.Of these cases,32 were neoplastic cavities(tumor group)and 19 were non-neoplastic cavities(non-tumor group).Results Non-infectious pulmonary cavity diseases mainly occurred in males,middle-aged and elderly people.All the cases are subacute or chronic,the main clinical symptoms are cough,sputum,hemoptysis,and some patients have fever.There were no significant differences in blood routine,neutrophil percentage and c-reactive protein between the tumor group and the non-tumor group(P>0.05).The misdiagnosis rate was 46.7%in the tumor group and 63.2%in the non-tumor group.The number of smokers in the tumor group,the daily smoking amount and the medical history time were significantly higher than those in the non-tumor group.The tumor markers of the tumor group were mostly positive.The ratio of cavity inner wall bulge,cavity wall enhancement,lobules,marginal burr and mediastinal lymph node enlargement in tumor group was significantly higher than that in non-tumor group(P<0.05).Multivariate Logistic regression analysis showed that smoking history and mediastinal lymphadenopathy were independent risk factors for the diagnosis of neoplastic pulmonary cavity disease,associated with other lung lesions and changes in reexamination of lung images are independent risk factors for the diagnosis of non-neoplastic pulmonary cavity disease.Conclusions The etiology of non-infectious pulmonary cavity disease is mostly neoplastic,and the imaging part has thecharacteristics of malignant tumor.When the characteristics are not obvious,it is easy to be misdiagnosed as infectious disease.Non-neoplastic and non-infectious pulmonary cavitation diseases are rare in clinic with complex etiology,and the pulmonary cavitation can be a process of disease development.When making the diagnosis,clinical and dynamic observation should be combined to reduce misdiagnosis,and the final diagnosis should be confirmed by pathology.