隐源性机化性肺炎18例的临床病理特征

目的回顾分析经病理确诊的隐源性机化性肺炎临床、病理和影像学特征,以提高临床诊断水平。方法1993年4月至2005年10月在北京协和医院住院、经病理确诊的机化性肺炎23例,对其进行临床、影像学和病理学综合分析。结果23例机化性肺炎中5例为药物引起或合并结缔组织病,18例为隐源性机化性肺炎(cryptogen ic organ izing pneumon itis,COP)。其中10例经皮肺活检或经支气管肺活检,8例开胸肺活检或经胸腔镜肺活检,男8例,女10例,年龄(53.5±11.0)岁。气短、咳嗽及肺部爆裂音及湿性啰音是主要的症状和体征。肺功能显示限制性通气功能障碍(11例)及弥散障碍(18例)。胸部CT表现为磨玻璃样变(4例),肺实变(13例)伴支气管充气征(3例),胸腔积液(4例)。支气管肺泡灌洗液中淋巴细胞占细胞总数的0.40±0.16,中性粒细胞为0.15±0.08,嗜酸粒细胞为0.05±0.03;CD4/CD8为0.43±0.21。所有患者均给予糖皮质激素治疗。16例患者经随诊(8.67±6.21)个月仍存活,临床缓解或病情稳定。1例患者对糖皮质激素反应差,死于进行性加重的呼吸衰竭。另1例患者糖皮质激素治疗后出现肺部感染,死于感染性休克。结论临床表现及影像学特征对COP的诊断有一定的提示作用,但确诊需依靠病理检查。经皮肺活检或经支气管镜肺活检结合支气管肺泡灌洗液检查,对临床诊断隐源性机化性肺炎有较高的价值。

Clinicopathologic features of 18 cases of cryptogenic organizing pneumonia

OBJECTIVE: To analyze the characteristics of pathologically proved cases of cryptogenic organizing pneumonia (COP) including manifestation of CT scan, bronchoalveolar lavage (BAL) fluid cytology, pulmonary histopathological appearance. METHODS: Twenty-three consecutive patients from April 1994 to October 2005 in Peking Union Medical College Hospital with pathologic features of organizing pneumonia were enrolled in the study. RESULTS: Eighteen patients were diagnosed as COP. Percutaneous lung biopsy/transbronchial lung biopsy was performed in 10 patients, while open lung biopsy/video-assistant thorascopic biopsy was performed in 8 patients. There were 8 males and 10 females, aged (53.5 +/- 11.0) yr. Dyspnea, cough, inspiratory crackles were the most common symptoms and signs. Lung function tests showed a restrictive ventilatory defect (11/18), and impairment of carbon monoxide transfer factor (T(LCO), 18/18). Chest computed tomography scan in 18 cases mainly showed ground glass opacities (4/18), patchy areas of alveolar consolidation (13/18) with air bronchograms (3/18), and pleural effusion (4/18). BAL fluid cytological analysis showed the percentage of lymphocyte was 0.40 +/- 0.16, neutrophil 0.15 +/- 0.08, eosinophil 0.05 +/- 0.03; the CD(4)/CD(8) ratio was 0.43 +/- 0.21. All patients were treated with corticosteroids. Sixteen were alive and clinically improved or stabilized at the last follow up (8.7 +/- 6.2 months after diagnosis). Two patients died, one of respiratory failure, and another of pulmonary infection. CONCLUSIONS: The diagnosis of COP is usually suggested by clinical-radiological findings, but needs to be confirmed histopathologically. The combination of BAL fluid cytological findings and lung histological appearance obtained during a bronchoscopic procedure appears to be an effective method for diagnosing this disease.