临床医生如何认识和处理病理报告的机化性肺炎  

How do clinicians recognize and deal with organizing pneumonia in pathology

作　　者：余勍[1] 阙呈立[1] Yu Qing;Que Chengli(Department of Respiratory and Critical Care Medicine,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院呼吸和危重症医学科,100034

出　　处：《中国综合临床》2021年第5期387-390,共4页Clinical Medicine of China

摘　　要：机化性肺炎(organizing pneumonia,OP)作为一种病理以肺泡腔、肺泡管或伴有细支气管内肉芽组织增生为组织病理学表现的临床综合征,随着肺活检技术的发展,通过病理诊断的OP逐渐增加,但多数在诊断时或随访中证实为继发性机化性肺炎(secondary organizing pneumonia,SOP)。SOP病因事关治疗的选择和预后,首先需要排除感染、找到结缔组织病的证据,或之前用药以及放疗甚至移植等诱因,多种病变特征的共存及同时累及肺血管和胸膜等提示可能的继发原因,空芯针穿刺或经支气管肺活检的病理诊断OP需要结合影像以避免遗漏OP周围的肿瘤、肉芽肿和坏死。治疗上无论隐源性或SOP,虽然有较高频率的复发,激素的效果都似乎优于其他肺间质病。总之,真正的隐源性OP实际上相对少见,慎重对待小标本诊断的OP,长期随访有助于了解病变的演变,对寻找真正的病因如肿瘤和结缔组织病至关重要。Objective Organizing pneumonia(OP)is a clinical syndrome manifested by granulation tissue plug in respiratory bronchioles,alveolar ducts and alveolar spaces pathologically.With advent of lung biopsy techniques,increasing pathological diagnosis of organizing pneumonia was made,most of which were confirmed secondary organizing pneumonia(SOP)either at time of diagnosis or on follow-up.The secondary etiology is related to the choice of treatment and prognosis.First of all,we need to rule out infection,find evidence of connective tissue disease,or previous medication,radiotherapy and even transplantation.The coexistence of multiple pathological features and simultaneous involvement of pulmonary vessels and pleura suggest possible secondary causes.The pathological diagnosis of organic pneumonia by empty core needle puncture or transbronchial lung biopsy needs to be combined with imaging to avoid omitting the tumor,granuloma and necrosis around organic pneumonia.In general,organizing pneumonia,no matter cryptogenic or secondary,is mostly responsive to corticosteroids compared with other interstitial lung diseases,although relapses are frequent.In summary,real cryptogenic organized pneumonia is actually relatively uncommon and should be diagnosed with caution.Long term follow up is not only crucial to assess the evolution of lung disease but also for looking into the underlying etiologies behind an organizing pneumonia.

关 键 词：机化性肺炎 病理学 解读 

分 类 号：R563.1[医药卫生—呼吸系统]