急性纤维素性机化性肺炎1例报道并文献复习  

Acute fibrinous and organizing pneumonia:one case report and literature review

作　　者：张宏英[1] 张楠[1] 刘加夫[1] 翁恒[1] 王岗玲[1] 林清[1] 

机构地区：[1]福建医科大学教学医院、福建省福州肺科医院呼吸二区,福州350008

出　　处：《中国感染与化疗杂志》2017年第4期371-375,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的提高对急性纤维素性机化性肺炎(AFOP)临床特征的认识。方法分析福州肺科医院收治的1例确诊AFOP,并通过万方数据库检索关键词"纤维素性机化性肺炎"进行文献复习。结果共检索到4篇文献9例病例,加上该院1例,共10例病例。男7例,女3例,年龄43~78岁。临床症状及检查:咳嗽8例,胸闷、气促、呼吸困难8例,发热9例,4例肺部闻及爆裂音,白细胞升高2例,中性粒细胞升高6例,C反应蛋白(CRP)升高9例,红细胞沉降率(ESR)增快8例,PO2波动于54~69 mm Hg;胸部CT有3例初始是单侧病变,7例双侧病变,影像特征主要为斑片、实变影、磨玻璃影,可伴有支气管充气征。确诊均通过病理活检,6例行肺穿刺,3例行纤维支气管镜(纤支镜),1例既做肺穿刺又做纤支镜检查。治疗均应用甲泼尼龙,无机械通气病例,死亡1例。结论 AFOP作为新型的间质性肺病,病因不明,好发于中老年人,临床表现类似"肺炎",易误诊,确诊有赖于组织病理,糖皮质激素疗效好,但激素用量、疗程无定论,远期疗效未知。Objective To further improve the awareness of the clinical feature of acute fibrinous and organizing pneumonia （AFOP）. Methods One case of AFOP treated in our department was described in details. The relevant cases were searched in Wanfang database using key words ＂acute fibrinous and organizing pneumonia＂ [in Chinese]. Results Four reports containing 9 cases were identified from published literature. A total of 10 cases （including this one） were analyzed. The patients included 7 males and 3 females （43 to 78 years of age）. Eight patients presented with cough. Chest tightness and dyspnea were reported in 8 cases, and fever in 9 cases. Velcro crackles were heard in 4 patients. Laboratory tests showed WBC increased in 2 eases, increased neutrophil count in 6 cases, elevated C-reactive protein in 9 cases, and faster erythrocyte sedimentation rate in 8 cases. The partial oxygen pressure （PO2） ranged from 54 mmHg to 69 mmHg. Chest CT scan showed unilateral lesions in 3 cases and bilateral lesions in 7 cases initially. The main CT findings were patchy, consolidation and ground-glass opacities, sometimes associated with air bronchogram. The diagnosis was confirmed by lung biopsy in all the 10 cases. Bronchoscopy biopsy was conducted in 6 cases, and percutaneous lung biopsy in 3 cases. One patient received both bronchoscopy biopsy and percutaneous lung biopsy. Methylprednisolone was used in all cases. No patient received mechanical ventilation. One patient died. Conclusions AFOP is a new type of interstitial lung disease, the etiology of which is unknown. AFOP often occurs in middle- and old-aged patients. AFOP is easily misdiagnosed due to its unspecific clinical manifestations, which are similar to common pneumonia. The confirmation of AFOP diagnosis depends on pathological biopsy. Corticosteroids treatment is appropriate, but the dosage, duration, and long term effect of corticosteroids are not established.

关 键 词：急性纤维素性机化性肺炎 临床特征 文献复习 

分 类 号：R563.1[医药卫生—呼吸系统]