急性纤维素性机化性肺炎2例并文献复习  

Acute fibrinous and organizing pneumonia:Two cases report and literature review

作　　者：苏清炎[1] 何子纲 姚向阳[1] SU Qingyan;HE Zigang;YAO Xiangyang(Dept.of Pulmonology,The First Affiliated Hospital of Xiamen Universit,Xiamen 361022,Fujian,China)

机构地区：[1]厦门大学附属第一医院肺科,福建厦门361022

出　　处：《武汉大学学报（医学版）》2021年第5期836-840,共5页Medical Journal of Wuhan University

摘　　要：目的:报告2例急性纤维素性机化性肺炎(AFOP)的诊治经过,并通过文献复习提高对AFOP的认识。方法:报道2例经病理证实的AFOP患者的诊治经过并复习相关文献。结果:病例1,女性,22岁,发热、咳嗽、咳痰,随后出现呼吸困难,胸部CT示双肺多发斑片实变影,抗细菌治疗无效,支气管镜肺活检病理符合AFOP,激素治疗后症状及影像学好转,随访2年无复发。病例2,女性,43岁,发热、咳嗽、咳痰,胸部CT示左肺斑片影,肺泡灌洗液采用下一代测序(NGS)检测出葡萄球菌,抗细菌治疗后症状缓解,复查胸部CT示肺部病变吸收不明显,经皮肺穿刺活检病理符合AFOP,停用抗细菌治疗,经激素治疗后影像显示吸收好转。结论:AFOP应该被视为组织学实体,而不是真正的临床疾病。它可以是特发性的或继发于多种原发疾病。临床医生不能仅依靠AFOP的典型组织学特征做出独立诊断,而应注意对潜在原发疾病的鉴别诊断。Objective:To report two cases of acute fibrinous and organizing pneumonia(AFOP),and review the related literature and improve the awareness on this disease.Methods:Two cases of AFOP confirmed by pathological diagnosis were described in details and the related literatures were reviewed.Results:Case 1,a 22-year-old female,presented with fever,cough and expectoration,and followed by dyspnea.Chest CT scan revealed multiple patchy consolidation in the bilateral lung lobe,and antibiotic treatment was ineffective.Specimens of the transbronchoscopic lung biopsy from the left lower lobe were sent for pathological examination,which demonstrated histological features consistent with AFOP.The patients showed significant clinical and radiological improvement after corticosteroid therapy.There was no signs of recurrence for two years of follow-up.Case 2,a 43-year-old female patient,presented with fever,cough,and expectoration.Chest CT showed patchy shadow of the left lobe.Staphylococci was detected in the bronchoscopic alveolar lavage fluid by next generation sequencing technology(NGS).The patient received antibacterial treatment and showed significant clinical improvement,but the left lower lobe consolidation changed insignificantly.Then specimens of the lung biopsy from the left lower lobe were sent for pathology which demonstrated intraalveolar spaces containing fibrin deposition(so-called fibrin balls)and organizing pneumonia.The patient showed significant radiological improvement after corticosteroid therapy.Conclusion:AFOP should be viewed as histological entities rather than true clinical disorders.It can be idiopathic or secondary to a variety of primary diseases.Clinicians can not rely solely on the typical histologic features of AFOP to confirm diagnosis of an independent clinical disorders,and should pay attention to the differential diagnosis of potential primary diseases.

关 键 词：急性纤维素性机化性肺炎 肺疾病 间质性 文献复习 

分 类 号：R563.9[医药卫生—呼吸系统]