急性纤维素性并机化性肺炎一例及文献复习  

Acute fibrinous and organizing pneumonia：a case report and review of the literature

作　　者：张捷[1] 方秋红[1] 冯瑞娥[3] 马迎民[1] 曹彧[1] 王仁贵[2] 

机构地区：[1]北京世纪坛医院呼吸科,100038 [2]北京世纪坛医院放射科,100038 [3]中国医学科学院北京协和医院病理科

出　　处：《中华结核和呼吸杂志》2010年第12期892-895,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 提高对急性纤维素性并机化性肺炎（AFOP）临床与病理特点的认识.方法 分析2009年12月收治的1例AFOP患者临床资料及诊治经过,并复习相关文献.结果患者男,73岁,临床表现为发热、咳嗽、咳少量白痰,伴有呼吸困难逐渐加重,胸部CT示双肺多发团片状影和结节影.经抗生素及抗真菌治疗无效,呼吸困难加重,胸部CT示双肺团片状影和结节影增多.B超引导下经皮肺穿刺活检病理表现为肺泡间隔略增宽,可见淋巴细胞和浆细胞浸润,肺泡腔内可见纤维母细胞呈息肉状延伸（机化）伴纤维素样红染物质,未见中性粒细胞和嗜酸粒细胞浸润,病变符合AFOP.经糖皮质激素治疗后症状很快缓解,胸部影像学改变明显好转.本例的临床特征与文献报道的AFOP亚急性型相一致.结论 AFOP的临床特征缺乏特异性,主要呈急性肺损伤的临床表现,确立诊断主要依赖组织病理学检查.目前尚无统一的治疗方案,糖皮质激素是主要治疗措施,但其剂最和疗程也未明确,且在糖皮质激素治疗减量的过程中还有复发的可能.Objective To better understand the clinical and pathological characteristics of acute fibrinous and organizing pneumonia （AFOP）.Methods A case diagnosed with AFOP was reported and the related literature was reviewed.Results A 73 year-old man presenting with fever,cough with small amount of white sputum and gradually worsening dyspnea was admitted to this hospital.Chest CT scan showed bilateral multiple nodules and patchy infiltrates.Treatment including anti-bacterial and anti-fungal drugs was initiated,but no improvement was observed.The dyspnea deteriorated and repeated chest CT showed an increase of the nodules and the patchy infiltrates.Ultrasound guided percutaneous lung biopsy was performed and the pathological examination revealed slightly widened alveolar septa,lymphocyte and plasma cell infiltration and the presence of intra-alveolar fibrin in the form of fibrin ＂balls＂ （organization） within the alveolar spaces.No neutrophil and eosinophil infiltration was detected.The finding was consistent with AFOP.Corticosteroid therapy was started and the patient showed significant clinical and radiological improvement after a course of treatment.The patient was discharged and followed in the outpatient clinic.The chest CT became nearly normal after treatment with corticosteroids for 1.5 months.Conclusions The main clinical manifestations of AFOP were similar to those of acute lung injury.Diagnosis was made by lung biopsy.The optimal treatment for AFOP had not been established.Therapy with corticosteroids could be attempted,but relapse may occur during the period of reducing the dosage of corticosteroids.

关 键 词：哺疾病 间质性 急性纤维素性并机化性肺炎 隐源性机化性肺炎 

分 类 号：R686[医药卫生—骨科学]