11例隐源性机化性肺炎的临床分析及诊治探讨  

Clinical analysis,diagnosis and treatment of 11 cases of cryptogenic organizing pneumonia

作　　者：明宗娟[1] 钟玉洁[1] 宁璞 张秋红[1] 李维[1] 杨拴盈[1] Ming Zongjuan;Zhong Yujie;Ning Pu;Zhang Qiuhong;Li Wei;Yang Shuanying(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China)

机构地区：[1]西安交通大学医学院第二附属医院呼吸与危重症医学科,710004

出　　处：《国际呼吸杂志》2019年第22期1717-1723,共7页International Journal of Respiration

基　　金：陕西省科技攻关计划项目(2018ZDXM-SF-042);西安交通大学第二附属医院基金重点项目(YJ(ZD)201510)。

摘　　要：目的分析隐源性机化性肺炎(COP)的临床表现并探讨其诊断条件、治疗方法,旨在提高对该病的警惕性和诊治水平。方法回顾性分析2012年1月至2018年7月西安交通大学医学院第二附属医院收治的11例COP患者的临床资料,包括临床症状、体征、实验室检查、影像学改变、肺功能及病理学检查等。结果11例患者中,男7例,女4例,年龄40~73岁,5例现吸烟或既往吸烟。除1例系体检发现外,其余10例均有呼吸道症状,如咳嗽、活动后呼吸困难及发热等,体征较为特异的为病变部位的爆裂音。血常规示白细胞正常或者轻度升高,C反应蛋白和血沉升高较为常见甚至显著,降钙素原均未见异常。胸部CT主要表现为斑片状浸润影、实变影及磨玻璃影,双下肺和胸膜下分布为主。血气可以正常,或轻度低氧血症,重者亦可见呼吸衰竭。典型COP的肺功能为限制性肺通气功能障碍和弥散功能下降。COP的确诊还需病理学依据,治疗主要选择糖皮质激素,整体预后良好。结论COP的临床表现缺乏特异性,极易误诊,辅助检查及影像学特征为COP的诊断提供了重要线索,但确诊有赖于临床-影像-病理的综合诊断。COP预后良好,糖皮质激素治疗有效。Objective To analyze the clinical manifestations of cryptogenic organizing pneumonia(COP)and discuss its diagnostic conditions and treatment methods in order to improve the level of vigilance and diagnosis.Methods Clinical data of 11 COP patients admitted to the Second Affiliated Hospital of Xi′an Jiaotong University from January 2012 to July 2018 were retrospectively analyzed,including clinical symptoms,signs,laboratory examination,imaging changes,pulmonary function and pathological examination.Results Among the 11 patients,7 were male and 4 were female,with the age ranging from 40 to 73 years old,and 5 were current or previous smokers.Except for one patient who was found in physical examination,all the other 10 patients had respiratory symptoms,with high incidence of cough,dyspnea and fever after activity,and specific signs of burst sound at the lesion site.Blood routine examination showed normal or slight increase of white blood cells,common or even significant increase of C-reactive protein and erythrocyte sedimentation rate,and no abnormality of procalcitonin.Chest CT showed patchy infiltrating shadows,consolidation shadows and ground glass shadows,mainly distributed in the lower lungs and subpleural.Blood gas can be normal,or mild hypoxemia,severe respiratory failure can also be seen.The pulmonary function of typical COP is restricted pulmonary ventilation dysfunction and decreased diffusion function.The diagnosis of COP requires pathological evidence,and the treatment mainly relies on glucocorticoid.The overall prognosis is good.Conclusions The clinical manifestations of COP are lack of specificity and easy to be misdiagnosed.Auxiliary examination and imaging characteristics provide important clues for the diagnosis of COP,but the diagnosis depends on the comprehensive diagnosis of clinical-image-pathology.COP has a good prognosis and glucocorticoid therapy is effective.

关 键 词：糖皮质激素类 隐源性机化性肺炎 临床表现 影像学特征 

分 类 号：R73[医药卫生—肿瘤]