中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

33 例隐源性机化性肺炎临床分析及诊治思考

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目的提高临床医生对隐源性机化性肺炎(COP)的认识及诊治水平。方法收集 2013 年 1 月 1 日至 2016 年 12 月 31 日 4 年期间在南京鼓楼医院住院、经病理确诊为 COP 患者的临床资料,回顾性分析其临床表现、实验室检查及影像学资料。结果符合纳入标准的 33 例患者中男 18 例,女 15 例,平均年龄(58.7±13.5)岁。患者多亚急性起病,最常见症状为咳嗽、发热、及不同程度的胸闷、呼吸困难等,约半数患者肺部可闻及吸气性爆裂音或捻发音。自身抗体及抗中性粒细胞胞浆抗体均为阴性。胸部高分辨率 CT 表现为肺内多发斑片状密度增高影或实变影,病变以两肺外周及胸膜下分布为主,多沿支气管血管束分布(28/33),少数为局灶结节影(5/33),可伴有肺门或纵隔淋巴结肿大(6/33)、胸腔积液等(2/33)等。25 例患者接受糖皮质激素治疗,6 例接受大环内酯类药物治疗,2 例未予药物治疗,以随访观察为主。结论临床表现、辅助检查及影像学特征是诊断 COP 的重要线索,确诊还需病理学依据,同时需要排除明确的致病原和潜在的基础疾病。

ObjectiveTo improve clinicians' awareness of cryptogenic organizing pneumonia (COP).MethodsThirty-three inpatients with COP, who had been diagnosed by pathology in Nanjing Drum Tower Hospital during January 2013 to December 2016 were collected. Their clinical manifestations, laboratory tests and imaging data were reviewed and analyzed retrospectively.ResultsThirty-three cases consisted of 18 males and 15 females, and the mean age was (58.7±13.5) years old. Most patients had subacute or insidious onset. The common symptoms were cough, fever, shortness of breath and chest tightness. About half of patients revealed inspiratory crackles or velcroes. Autoantibodies and anti-neutrophil cytoplasmic antibodies were negative. High-resolution computerized tomography findings of COP included bilateral patchy areas of air-space consolidation that showed predominantly subpleural or peri-bronchovascular distribution, focal nodules, enlarged hilar or mediastinal lymph nodes and pleural effusion. 25 patients were treated with glucocorticoid, 6 with macrolid, and 2 were only followed up without drug treatment.ConclusionsClinical manifestations, laboratory tests and imaging features are important clues to diagnose COP. Diagnosis depends on pathology. Meanwhile, definite pathogen and potential underlying diseases must be excluded.

关键词: 隐源性机化性肺炎; 肺组织活检术; 高分辨率 CT

Key words: Cryptogenic organizing pneumonia; Lung biopsy; High resolution CT

引用本文: 夏德刚, 杨长雨, 夏伟, 陈广峰, 张英为. 33 例隐源性机化性肺炎临床分析及诊治思考. 中国呼吸与危重监护杂志, 2018, 17(5): 461-464. doi: 10.7507/1671-6205.201711011 复制

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