24例隐源性机化性肺炎的回顾性研究  

Retrospective Clinical Analysis of 24 Patients with Cryptogenic Organizing Pneumonia

作　　者：赵必君[1] 曾凡军[1] 李淑华 龚正[1] 王永全[1] 张凌云[1] 范晓飞 何桂媛 陆志凌 Zhao Bijun;Zeng Fanjun;Li Shuhua;Gong Zheng;Wang Yongquan;Zhang Lingyun;Fan Xiaofei;He Guzyuan;Lu ZhzUng(Department of Respiratory and Critical Care Medicine,Yichang Central Peoples Hospital,The First College of Clinical Medical Science,China Three Gorges University & Institute of Respiratory,China Three Gorges University,Yichang443003,China)

机构地区：[1]三峡大学第一临床医学院(宜昌市中心人民医院)呼吸与危重症医学科&三峡大学呼吸病研究所,湖北宜昌443003

出　　处：《巴楚医学》2021年第3期22-26,共5页Bachu Medical Journal

基　　金：湖北省卫生计生基金项目(No:WJ2015MB206)。

摘　　要：目的:探讨隐源性机化性肺炎(COP)的临床特点、影像学特点及治疗效果。方法:回顾性分析我科2017年6月~2019年6月收治的24例COP患者资料,总结并分析其临床及影像学特点,观察其治疗效果。结果:24位患者中,男性16例,女性8例,平均年龄58岁。早期临床症状主要为干咳和反复发热,后期可出现呼吸困难。胸部CT的表现具有多态性和迁移性,主要特征性表现为多发斑片状肺实变及支气管充气征,病变多沿支气管血管束分布,少数表现为病灶外周的磨玻璃影及小叶周围的异常密度影。单肺病变8例,累及下肺16例,合并胸腔积液3例,合并坏死及空洞形成3例。部分患者PET-CT提示病灶代谢明显升高。所有患者均给予规范化糖皮质激素治疗,病情稳定后逐渐减量,总疗程6~9个月。结论:COP的诊断需综合临床、影像及病理,其临床表现无特异性,但部分影像学表现具有特异性。糖皮质激素治疗COP疗效肯定。Objective:To investigate the clinical features,imaging features and therapeutic effects of cryptogenic organizing pneumonia(COP).Methods:A total of 24 cases of COP diagnosed in our hospital from June 2017 to June 2019 were retrospectively analyzed.Their clinical features,imaging characteristics and therapeutic effects were analyzed.Results:Among 24 cases,there were 16 males and 8 females,with the mean age of 58 years old.The main symptoms onset were dry cough and recurrent fever.Some patients were performed with dyspnea in the late stage.The imaging features were polymorphic and migratory.The main manifestations were multiple patchy lung consolidation and bronchial inflation signs.The lesions were mostly distributed along the bronchial vascular bundle.Some specific features were ground glass opacity around the lesion,and abnormal density around the lobules.There were 8 cases of single lung lesion,and 16 cases of lower lung involvement.There were 3 cases complicated with pleural effusion,and 3 cases with necrosis and cavity formation.PET-CT indicated that the metabolism of the lesion was significantly increased in part of the patients.All patients were treated with standardized glucocorticoids,with gradually decrease of dose under the stable condition.The total course of treatment was 6 to 9 months.Conclusion:Clinical manifestations,imaging features and pathological changes are important clues to diagnose COP.The clinical manifestations are not specific,but some of specific imaging features are helpful for clinical diagnosis.The therapeutic effect of glucocorticoid on COP is positive.

关 键 词：隐源性机化性肺炎 肺通气 糖皮质激素 

分 类 号：R563[医药卫生—呼吸系统]