隐源性机化性肺炎及结缔组织病相关性机化性肺炎的临床及影像特点分析  

Analysis for differences in clinical and radiologic findings between patients with cryptogenic organizing pneumonia and connective tissue disorder related organizing pneumonia

作　　者：沈威[1] 李慧[1] 代静泓[1] 苗立云[1] 肖永龙[1] 曹敏[1] 黄妹[1] 曹孟淑[1] 孟凡青[2] 蔡后荣[1] 

机构地区：[1]南京大学医学院附属鼓楼医院呼吸科,210008 [2]南京大学医学院附属鼓楼医院病理科,210008

出　　处：《中华结核和呼吸杂志》2015年第9期669-674,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金（81470253）

摘　　要：目的 探讨隐源性机化性肺炎（COP）和结缔组织病相关性机化性肺炎（CTD-OP）的临床表现和影像学特点.方法 回顾性分析南京鼓楼医院2005-2013年52例经病理证实的机化性肺炎资料,其中男24例,女28例,平均年龄（55±11）岁,30例为COP,22例为CTD-OP.结果 CTD-OP的原发病多为干燥综合征、皮肌炎/多发性肌炎、类风湿关节炎,两组患者在咳嗽、咳痰、咯血、呼吸困难、发热及胸痛等临床表现方面无明显差别,CTD-OP组女性患者比例（17/22）明显高于COP组（11/30,P＜0.01）,两组肺功能损害均以限制性通气功能障碍为主,组间比较差异无统计学意义（P＞0.05）;两组ANA阳性率有明显差异（CTD-OP组14/22,COP组3/30,P＜0.01）;两组影像学改变无明显差异,均以斑片状实变影、条索状影及磨玻璃影最常见,部分患者表现为孤立性块状影,少量患者伴有胸腔积液;网格样改变少见;分布均以两肺胸膜下最常见,可沿支气管血管束分布.结论 COP和CTD-OP患者的呼吸道症状和影像学表现无明显差异,CTD-OP组中女性患者比例、ANA阳性率、关节痛及皮疹等肺外症状明显高于COP组.Objective To investigate the difference in clinical features and radiologic findings between patients with cryptogenic organizing pneumonia （COP） and connective tissue disorder related organizing pneumonia （CTD-OP）.Methods A total of 30 subjects with COP and 22 subjects with CTD-OP collected from 2005 to 2013 were retrospectively reviewed in the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School,and the diagnosis of all patients were confirmed by lung biopsy.Results The common underlying diseases in patients with CTD-OP were Sjogren syndrome （SS）,poly-/ dermatomyositis（PM/DM）,rheumatoid arthritis （RA）.There were no significant differences in clinical manifestations between CTD-OP and COP.Compared with COP patients,the proportion of female patients was higher in CTD-OP.Higher positive rate for ANA was found in CTD-OP group（CTD-OP：63.6%;COP：10.0%;P 〈0.01）.There were no significant differences in parameters of lung function between CTD-OP and COP.As to radiological findings,the most common patterns were multiple patchy,linear shadows and ground-glass opacity.Some patients showed solitary nodule or consolidation and pleural effusion.Reticular shadow was a rare pattern among these patients.Most lesions were under the pleura and/or around the bronchus.Conclusions There are no significant differences in clinical and radiologic manifestations between COP and CTD-OP,except that the proportion of women and ANA positive rate were higher in CTD-OP.

关 键 词：隐源性机化性肺炎 结缔组织病相关性机化性肺炎 临床表现 高分辨率CT 

分 类 号：R563.1[医药卫生—呼吸系统]