隐源性机化性肺炎与继发性机化性肺炎的临床特点及预后分析

Analysis of Clinical Characteristics and Prognosis of Cryptogenic and Secondary Or-ganizing Pneumonia

目的:探讨隐源性机化性肺炎(COP)和继发性机化性肺炎(SOP)临床特点、预后,以便提高临床诊断及治疗水平。方法:回顾性分析于烟台毓璜顶医院住院经病理确诊的65例机化性肺炎(OP)患者的临床资料, 其中COP 28例、SOP 37例,对比分析两组的一般资料、临床表现、实验室检查数据、肺功能检查结果、胸部CT影像学特点、治疗方案及预后的差异。结果:COP与SOP患者临床特征相似,多为急性或亚急性起病。发热、咳嗽、咳痰、呼吸困难是最常见的症状,肺部爆裂音(velcro啰音)、湿啰音、发绀是最常见的阳性体征。与COP组相比,SOP组出现发热、咳痰、湿啰音的比例更高(P < 0.05)。两组均出现血清白蛋白下降,C反应蛋白、血沉、降钙素原、纤维蛋白原水平升高,支气管肺泡灌洗液细胞分类常显示中性粒细胞比例升高、巨噬细胞比例下降。SOP组的白细胞计数、中性粒细胞百分比、D-二聚体水平显著高于COP组(P < 0. 05),白蛋白、血红蛋白显著低于COP组(P < 0. 05),其余实验室指标差异无统计学意义。两组肺功能检查结果差异无统计学意义。SOP组胸部CT影像学表现实变型比例、胸腔积液发生率高于COP组(P < 0.05)。OP患者的治疗反应和预后和通常都很好,SOP组治疗有效率低于COP组,进展率高于COP组(P < 0.05)。结论:COP和SOP患者的临床和影像学表现相似且非特异性,两组临床特点存在一定差异,有助于鉴别COP和SOP。某些实验室指标异常在SOP中更常见,可能是由基础疾病引起的。SOP对激素反应差,预后较差。

Objective: To investigate the clinical characteristics and prognosis of cryptogenic organizing pneu-monia (COP) and secondary organizing pneumonia (SOP), so as to improve the clinical diagnosis and treatment level. Methods: The clinical data of 65 patients with organizing pneumonia (OP) diag-nosed pathologically in Yuhuangding Hospital of Yantai were retrospectively analyzed, including 28 cases of COP and 37 cases of SOP. The differences of general data, clinical manifestations, laboratory examination data, lung function examination results, chest CT imaging features, treatment plan and prognosis between the two groups were compared and analyzed. Results: The clinical characteris-tics of COP and SOP patients were similar, most of them were acute or subacute onset. Fever, cough, sputum, dyspnea were the most common symptoms, and lung burst (velcro rales), wet rales, cyano-sis were the most common positive signs. Compared with the COP group, the SOP group had higher rates of fever, sputum, and wet rales (P < 0.05). Serum albumin decreased and C-reactive protein, erythrocyte sedimentation, procalcitonin and fibrinogen increased in both groups. Cell classification in bronchoalveolar lavage fluid often showed an increase in the proportion of neutrophils and a de-crease in the proportion of macrophages. The white blood cell count, neutrophil percentage and D-dimer level in SOP group were significantly higher than those in COP group (P < 0.05), while al-bumin and hemoglobin were significantly lower than those in COP group (P < 0.05), and there was no statistical significance in other laboratory indexes. There was no significant difference in lung function between the two groups. The proportion of chest CT imaging results and the incidence of pleural effusion in SOP group were higher than those in COP group (P < 0.05). The treatment re-sponse and prognosis of OP patients were generally good. The response rate of SOP patients was lower than that of COP group and the rate of progression was higher than that of COP group (P < 0.05). Conclusions: The clinical and imaging findings of COP and SOP patients are similar and non-specific, and there are some differences in clinical features between the two groups, which is helpful for the identification of COP and SOP. Certain laboratory indicator abnormalities are more common in SOP and may be caused by underlying disease. SOP is poorly responsive to hormones and has a poor prognosis.