隐原性与继发于结缔组织病的机化性肺炎的临床特征及预后对比分析  

Comparative Analysis on Clinical Characteristics and Prognosis between Cryptogenic Organizing Pneumonia and Connective Tissue Disease-related Organizing Pneumonia

作　　者：张梅[1] 赵云峰[2] 骆益民[1] 王忠江[3] 刘磷琛[4] 杨远[1] 王西华[1] 林勇[1] 

机构地区：[1]东南大学附属中大医院呼吸内科,江苏省南京市210009 [2]上海市浦东新区公利医院呼吸科 [3]东南大学附属中大医院放射科,江苏省南京市210009 [4]东南大学附属中大医院风湿免疫科,江苏省南京市210009

出　　处：《中国全科医学》2014年第14期1595-1599,共5页Chinese General Practice

基　　金：江苏省卫生厅面上科研课题(H201031)

摘　　要：目的对比分析隐原性与继发于结缔组织病的机化性肺炎（OP）的临床特征及预后。方法采用回顾性研究,选取东南大学附属中大医院2006年2月—2012年1月期间37例经病理证实的OP住院患者,根据临床症状、肺功能检查、免疫学检查和胸部高分辨率CT（HRCT）扫描等结果,结合典型的OP组织病理表现,经有经验的呼吸科、风湿科、放射科及病理科医生会诊后,剔除5例病因为药物、放射性治疗或感染所致的OP患者,最终纳入32例作为研究对象,并将其分为隐原性机化性肺炎（COP）组（14例）及继发于结缔组织病机化性肺炎（CTD-OP）组（18例）。两组患者给予糖皮质激素治疗3~12个月,随访18个月。比较两组患者的临床症状、肺功能指标、动脉血气分析指标、影像学特征及预后情况。结果两组患者的年龄、呼吸困难发生率、氧合指数（PaO2/FiO2）及C反应蛋白（CRP）比较,差异均无统计学意义（P〉0.05）;CTD-OP组的女性比例、类风湿因子（RF）阳性率、抗核抗体（ANA）阳性率均高于COP组（P〈0.05）。两组间第1秒用力呼气容积占预计值百分比（FEV1%）、用力肺活量占预计值百分比（FVC%）、肺总量占预计值百分比（TLC%）、残气量占预计值百分比（RV%）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）、一氧化碳弥散量占预计值百分比（DLCO%）、动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、肺泡-肺动脉氧分压差〔P（A-a）O2〕分别在治疗前和治疗后比较,差异均无统计学意义（P〉0.05）。组内比较显示,治疗前两组患者的FEV1%、FVC%、TLC%、RV%、FEV1/FVC、DLCO%、PaO2、P（A-a）O2与治疗后比较,差异均有统计学意义（P〈0.05）。两组的治疗方案比较,差异无统计学意义（P〉0.05）。两组患者经激素治疗后总有效率为93.8%（30/32）;两组的预后情况比较,差异有统计学意义（u=-2.080,P=0.038）;COP组的Objective To compare the clinical features and prognosis between cryptogenic organizing pneumonia（COP） and connective tissue disease related organizing pneumonia（CTD-OP）.Methods 37 in-patients diagnosed with OP by lung biopsy in Zhongda Hospital Affiliated of Southeast University from February 2006 to January 2012 were retrospectively studied.Five patients caused by medication,radioactive therapy and infection were removed from the study according to clinical features,lung function examination,immunologic test and HRCT as well as confirmation by experienced doctors.32 patients were finally involved into the study and were randomly divided into COP group（14 cases） and CTD-OP group（18 cases）.The two groups were treated by glucocorticoid for 3 to 12 months and were followed up for 18 months.The clinical features,lung function index,analysis index of arterial blood gases,imaging characteristics and prognosis were compared between the two groups.Results The age,dyspnea,PaO2/ FiO2and CRP between the two groups showed no statistically significant difference（P〈0.05）.The incidence of women,the positive rate of serum RF and ANA in CTD-OP group were higher than in COP group（P〈0.05）.FEV1%,FVC%,TLC%,RV%,FEV1/ FVC,DLCO%,PaO2,PaCO2and P（A-a） O2between the two groups showed no statistically significant difference before and after treatment（P〈0.05）.Comparison within groups showed that the FEV1%,FVC%,TLC%,RV%,FEV1/ FVC,DLCO%,PaO2and P（A-a） O2before treatment both showed statistically significant differences（P〈0.05）.The treatment schemes between the two groups showed no statistically significant difference（P〈0.05）.The overall effective rate of the two groups after treated by glucocorticoid was 93.8%（30 /32）,and the prognosis between the two groups showed statistically significant difference（u =-2.080,P = 0.038）.The cure rate of the COP group（50.0%） was higher than the CTD-OP group（16.7%）,and the recurrence rate of the COP group（7.1%） was lower than the CTD-OP

关 键 词：隐原性 结缔组织疾病 机化性肺炎 体征和症状 预后 

分 类 号：R563.1[医药卫生—呼吸系统]