1例隐源性机化性肺炎误诊病例分析及反思  

Analysis and reflection on a misdiagnosis case of cryptogenic organic pneumonia

作　　者：高慧[1] 林锋[1] 吴彪[1] 施理[1] 张秀春[1] GAO Hui;LIN Feng;WU Biao;SHI Li;ZHANG Xiuchun(Department of Infectious Disease,Hainan General Hospital,Haihou,Hainan 570311,China)

机构地区：[1]海南省人民医院感染科

出　　处：《中国热带医学》2019年第8期798-800,共3页China Tropical Medicine

基　　金：国家自然科学基金(No.81260264)

摘　　要：目的掌握隐源性机化性肺炎(cryptogenic organizing pneumonia COP)的临床特点,提高临床医生对COP的诊断水平、尽量做到避免或降低漏诊、误诊,达到有效治疗。方法对海南省人民医院收治的1例隐源性机化性肺炎的临床表现、实验室检查、影像学资料进行回顾性分析及研究。结果本例患者因"反复咳嗽、胸闷5月余"就诊,先后经抗结核、抗感染及抗真菌治疗后病灶增多,最后经皮肺组织活检术,病理结果提示机化性肺炎,排除其他原因所致机化性肺炎后考虑诊断隐源性机化性肺炎,经糖皮质激素规范治疗近10个月后停药,病灶基本吸收,停药后定期复查,随诊2年后无复发。结论本病例临床少见,症状不典型,实验室检查及无创检查难以诊断本病,明确诊断需及时尽早行支气管镜活检或经皮肺穿刺活检等有创检查,从而得到早期诊断及治疗。Objective To master the clinical characteristics of cryptogenic organizing pneumonia(COP),improve the diagnostic level of COP by clinicians,and try to avoid or reduce missed diagnosis and misdiagnosis,so as to achieve effective treatment.Methods The clinical manifestations,laboratory tests and imaging data of a patient with COP admitted to Hainan General Hospital were reviewed and analyzed retrospectively.Results In this case,because of repeated cough and chest tightness for more than 5 months,the patient admitted to our hospital.The number of lesions increased after anti-tube.rculosis,anti-infection and anti-fungal treatment,and finally by percutaneous lung biopsy,pathological results showed that organic pneumonia,excluding organic pneumonia caused by other causes,was considered for the diagnosis of cryptogenic organic pneumonia.Drugs were stopped after standard treatment with glucocorticoid for nearly 10 months,and the lesions were basically absorbed.After withdrawal,the patients were reviewed regularly,and no recurrence occurred after 2 years of followup.Conclusions It is difficult to diagnose this disease by laboratory examination and non-invasive examination because of its unusual clinical features and atypical symptoms.To make a definite diagnosis,invasive examinations such as bronchoscopic biopsy or percutaneous puncture biopsy should be performed as soon as possible so as to obtain early diagnosis and treatment and relieve patients’ pain.

关 键 词：隐源性机化性肺炎 间质性肺炎 肺组织活检 误诊 高分辨率CT 肺结核 糖皮质激素 

分 类 号：R563.1[医药卫生—呼吸系统]