肺活检证实隐源性机化性肺炎25例临床诊治体会

目的分析25例经肺活检确诊的隐源性机化性肺炎（COP）患者的临床资料,总结COP的临床、影像学、病理学、转归与预后等特点,以指导临床实践。方法收集2000年1月至2006年4月期间经肺活检证实的25例COP患者的所有资料,对其易患因素、临床表现、影像学表现、病理改变、常规生化检查等进行统计学处理和综合分析。主要治疗方法为糖皮质激素（简称激素）静脉滴注和口服序贯疗法。结果25例中男6例,女19例,男：女为1：3．17;年龄40-73岁,平均（56±9）岁;起病到确诊时间为1—241个月,平均〉16个月,中位数为3个月;随访时间为2—71个月,中位数为22个月。近半数患者有药物过敏史、各种工业粉尘和植物粉尘接触史;与吸烟的关系不甚密切。临床症状缺乏特征性,主要为咳嗽、气促等呼吸系统症状,少数有低热、盗汗、乏力等全身症状。影像学表现具有“五多一少”的特点（多态性、多发性、多变性、多复发性、多双肺受累,蜂窝肺少见）。肺功能表现为轻度通气功能障碍,残气容积增加,弥散功能受损。19例完全治愈,但有8例复发;其余6例均有不同程度的好转,但有1例急性加重。复发多发生在1年半至2年间激素停药或减量至5—10mg／d时。治愈后复发病例的激素用药时间[（19±6）个月]明显短于未复发者[（29±12）]个月。结论COP在我国并非少见。基于临床、影像学、病理学资料的综合分析是最重要的诊断方法。激素为首选治疗用药,其中静脉滴注和口服序贯疗法具有起效快、不良反应小和依从性好等优点。本病预后良好,但复发率较高。

Clinical analysis of 25 cases of biopsy-proven cryptogenic organizing pneumonia

OBJECTIVE: To analyze the clinical, radiological and pathological features, diagnosis and response to therapy as well as prognosis of 25 cases of cryptogenic organizing pneumonia (COP). METHODS: Twenty-five subjects with COP confirmed by lung biopsy in Shanghai Pulmonary Hospital from January of 2000 to April of 2006 were retrospectively reviewed. Secondary reaction to infections, drugs, radiation, connective tissue diseases and various noxious agents were excluded. Their clinical-pathological characteristics, radiological features, response to treatment, relapse, survival were obtained from medical records and a follow-up patient questionnaire. RESULTS: There were 6 males and 19 females, with a mean age of 56 years (range 40 - 73 years). The presentations included cough (25/25), clear sputum (21/25), dyspnea (17/25), hemoptysis (5/25), fever and sweats (3/25), and "Velcro" crackles (18/25). Four of them were smokers, 11 had allergic reaction to some drugs, and 11 had some industrious dust inhalation. In 23 cases the specimens were obtained by video-assisted thoracoscopy and 2 cases by transbronchial lung biopsy. Bilateral lung involvement was present in 23 cases and all of them had at least two different radiological manifestations. Twenty-four cases showed a sub-pleural distribution. Bilateral patchy alveolar and ground glass involvement were found in 8 cases, airspace consolidation in 8 cases, mass in 11 cases, irregular lines in 10 cases, small nodules (<10 mm) in 4 cases. Two patients received operation. Corticosteroid therapy was administered to 23 patients. Seventeen cases were cured, but 8 of them relapsed after stopping (n = 2) and tapering (n = 6, when prednisone less than 5 - 10 mg/d) of corticosteroids within one to two years of therapy. CONCLUSIONS: COP is not very rare in China. The clinical-radiological-pathological diagnosis (CRP) is the most important diagnostic method. Corticosteroid is the first choice for COP therapy. The prognosis of COP is good if therapy is started in time, but relapse is common.