局灶性机化性肺炎73例临床分析  

Clinical analysis of 73 cases of focal organizing pneumonia

作　　者：葛艳[1] 李南 朱岩[3] 金淑贤 余秋里 GE Yan;LI Nan;ZHU Yan;JIN Shu-xian;YU Qiu-li(Department of Respiratory Medicine,Rugao People's Hospital,Rugao,Jiangsu226500,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu210029,China;Department of Pathology,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu210029,China)

机构地区：[1]如皋市人民医院呼吸内科,江苏如皋226500 [2]南京医科大学第一附属医院,江苏省人民医院呼吸与危重医学科,江苏南京210029 [3]南京医科大学第一附属医院,江苏省人民医院病理科,江苏南京210029

出　　处：《临床肺科杂志》2019年第10期1780-1784,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的观察局灶性机化性肺炎(FOP)的临床特点、病理特征和影像学表现,以提高临床诊断率及救治水平。方法回顾性分析2013-2018年在江苏省人民医院住院经病理确诊的73例FOP患者的临床资料,对其临床特点、病理特征、实验室检查(肿瘤标记物和D-二聚体)、影像学表现、治疗等综合分析。结果(1)73例局灶性机化性肺炎患者中,男性52例,占总体的71.23%,女性21例,占28.77%,最大年龄82岁,最小年龄26岁,平均年龄为56.05±10.21岁。(2)临床表现中,有咳嗽咳痰症状51例,有发热21例,有咯血16例,有胸痛20例,体检发现15例。(3)部位及大小,病变在肺野内、中、外带均有发生,其中,左肺上叶17例,下叶15例,右肺上叶21例,右肺中叶3例,右肺下叶17例。病灶范围大于3cm的39例,小于3cm的34例。(4)实验室检查:77例患者中,CEA增高4例,CA199增高1例,NSE增高12例,D-二聚体增高12例。(5)PET-CT,共有11例患者行PET-CT检查,其中8例患者均有不同程度糖代谢增高,提示恶性病变可能;3例未见FDG代谢增高,考虑炎症后改变。(6)治疗,73例患者中,手术40例,未手术33例;未手术的33例患者中,单独抗感染治疗的13例,抗感染病灶无吸收后用激素或同时用激素的18例,未处理的2例。(7)预后,40例手术患者中,1例患者半年后复查手术缝线周围复发;33例未手术患者随访2周至2年,28例病灶完全吸收,2例因咯血及病灶增大行手术治疗,1例合并白血病预后不佳,2例未复查。结论局灶性机化性肺炎因其特殊的影像学表现误诊率较高,确诊有赖于基本信息、临床特征、影像、实验室检查、病理特征等的综合诊断,一般预后良好。Objective To observe the clinical features,pathological features and imaging findings of focal organizing pneumonia(FOP)in order to improve the clinical diagnosis rate and treatment level.Methods The clinical data of 73 patients with FOP diagnosed by pathology in the People's Hospital of Jiangsu Province from 2013 to 2018 were retrospectively analyzed.We analyzed their clinical manifestations,pathological features,laboratory tests(tumor markers and D-dimer),imaging performance and treatment.Results(1)Of the 73 patients with focal organizing pneumonia,52 were male,accounting for 71.23%of the total;and 21 were female,accounting for 28.77%.The maximum age was 82,the minimum age was 26,and the average age of onset was 56.05±10.21 years old.(2)In clinical manifestations,there were 51 cases of cough and expectoration,21 cases of fever,16 cases of hemoptysis,20 cases of chest pain,and 15 cases had no any symptoms.(3)The location of the lesions occurred in middle and outer zones,including 17 cases of the left upper lobe,15 cases of the left lower lobe,21 cases of the right upper lobe,3 cases of the right middle lobe,and 17 cases of the right lower lobe.There were 39 cases with lesions larger than 3cm and 34 cases with lesions less than 3cm.(4)Laboratory examination:among 77 patients,4 cases had elevated CEA,1 case had increased CA199,12 cases had increased NSE,and 12 cases had D-dimer increase.(5)A total of 11 patients underwent PET-CT examination,8 patients showed different degrees of increased FDG metabolism,suggesting malignant lesions;and 3 cases did not see increased FDG metabolism,considering inflammatory changes.(6)Of the 73 patients,40 cases were operated,and 33 cases were not operated.Among the 33 cases without surgery,13 cases were treated only with antibiotics,and 18 cases were treated with antibiotics and hormones.2 cases did not undergo any treatment.(7)Among the 40 surgical patients,1 patient recurred after half a year,and 33 patients without surgery were followed up for 2 weeks to 2 years.The lesions in 2

关 键 词：局灶性机化性肺炎 临床特点 诊断 预后 

分 类 号：R563.1[医药卫生—呼吸系统]