隐源性机化性肺炎44例临床分析

发布时间：2019-03-05 07:30

【摘要】：目的:总结隐源性机化性肺炎的临床、影像学、病理学等特点,比较隐源性机化性肺炎不同亚型之间在临床表现、炎症指标、肺功能等方面的差异,旨在提高对隐源性机化性肺炎不同亚型的认识及诊治能力。方法:对广西医科大学第一附属医院2012年3月至2017年3月收治的经病理确诊的44例隐源性机化性肺炎的临床表现、炎症指标、肺功能、影像学表现、活检方式以及治疗方法、预后等临床资料进行回顾性分析,根据不同的影像学表现分组,比较不同组别之间的差异。结果:在44例隐源性机化性肺炎患者中,男性26例,占总体的59.09%,女性18例,占40.91%,平均发病年龄为54.77±13.81岁。根据影像学特点分为肺炎型COP组(24例)、局灶型COP组(20例)。(1)临床表现:病程多在2-12周,主要为咳嗽(88.64%)、咳痰(65.91%)、胸痛(34.09%)、气促或呼吸困难(27.27%)、咳血(13.64%)、胸闷(9.09%)、伴有发热(50%)、畏寒(9.09%)、乏力(9.09%)等症状。31.81%患者中闻及湿罗音,肺炎型COP组较局灶型COP出现湿罗音的例数多。(2)炎症指标:28例白细胞计数正常,占63.64%,32例中性粒细胞百分比正常,占72.73%;10例CRP正常,占22.73%;9例ESR正常,占20.45%。肺炎型COP组:白细胞计数为9.15±3.85×109/L,中性粒细胞百分比0.72±0.11%,C-反应蛋白29.41±89.58g/L,血沉51.83±31.31mm。局灶型COP组:白细胞计数为7.46±4.49×109/L,中性粒细胞百分比0.62±0.10%,C-反应蛋白12.26±34.26g/L,血沉35.45±24.49mm。(3)肺功能检查:25%弥散功能正常,75%不同程度的弥散功能障碍(轻度25%,轻中度10.71%,中度32.14%,重度7.14%);35.71%通气功能正常,28.57%表现为混合性通气功能障碍,25%表现为阻塞性通气功能障碍,25%为限制性通气功能障碍。肺炎型COP组弥散功能较局灶型差。(4)经TBLB获取肺组织确诊者占56.82%,B超引导下经皮肺活检者占52.27%,外科手术占4.54%,经胸腔镜下获取肺组织占4.54%。肺炎型COP组采取TBLB方式获取肺组织者占79.2%,采用B超引导下经皮肺活检方法者只占15.4%。局灶型COP组采用B超引导下经皮肺活检的占75%,采用TBLB者占30%。(5)激素治疗效果好,约16.13%出现复发,两组间无差异。结论:1.COP临床表现无明显特异性,影像学多表现为多发的肺泡实变影以及局限性的实变影。2.影像学表现为肺炎型的患者更易出现咳痰、气促或呼吸困难、乏力等症状,肺部查体时湿罗音亦更常见。3.糖皮质激素治疗效果好,部分患者有复发。
[Abstract]:Objective: to summarize the clinical, imaging and pathological features of Cryptogenic Organizing pneumonia, and to compare the differences in clinical manifestation, inflammatory index and pulmonary function among different subtypes of Cryptogenic Organizing pneumonia. The aim of this study was to improve the understanding, diagnosis and treatment of different subtypes of Cryptogenic Organizing pneumonia. Methods: from March 2012 to March 2017 in the first affiliated Hospital of Guangxi Medical University, 44 cases of Cryptogenic Organizing pneumonia were treated by pathology, including clinical manifestation, inflammatory index, pulmonary function, imaging manifestation, biopsies and treatment. The clinical data, such as prognosis, were analyzed retrospectively, and the differences among different groups were compared according to different imaging manifestations. Results: of the 44 patients, 26 (59.09%) were male and 18 (40.91%) were female. The mean age of onset was 54.77 卤13.81 years old. According to the imaging features, they were divided into pneumonia type COP group (24 cases), focal type COP group (20 cases). (1), clinical manifestation: the course of disease was more than 2 weeks, mainly cough (88.64%), expectoration (65.91%), chest pain (34.09%). Symptoms such as shortness of breath or dyspnea (27.27%), hemoptysis (13.64%), chest tightness (9.09%), fever (50%), cold dread (9.09%), fatigue (9.09%). (2) inflammation index: the leukocyte count was normal in 28 cases (63.64%), the percentage of neutrophils in 32 cases was normal (72.73%), and the percentage of neutrophils in 32 cases was normal (72.73%). CRP was normal in 10 cases (22.73%), ESR was normal in 9 cases (20.45%). In COP group, leukocyte count was 9.15 卤3.85 脳 109 mL, neutrophil percentage 0.72 卤0.11%, C-reactive protein 29.41 卤89.58 g / L, erythrocyte sedimentation rate 51.83 卤31.31 mm. In focal COP group, leukocyte count was 7.46 卤4.49 脳 109 mL, neutrophil percentage 0.62 卤0.10%, C-reactive protein 12.26 卤34.26 g / L, ESR 35.45 卤24.49 mm 路(3) normal pulmonary function in 25%. 75% diffuse dysfunction (mild 25%, mild to moderate 10.71%, moderate 32.14%, severe 7.14%); The ventilatory function was normal in 35.71%, mixed ventilation in 28.57%, obstructive ventilation in 25% and restrictive ventilation in 25%. (4) the pulmonary tissue was diagnosed by TBLB (56.82%), B-ultrasound guided percutaneous lung biopsy (52.27%), surgical operation (4.54%) and thoracoscopy (4.54%), respectively. (4) the diffusion function of COP group was worse than that of local type. (4) the pulmonary tissue was confirmed by TBLB, 52.27% by B-ultrasound, 4.54% by thoracoscope. In pneumonia type COP group, 79.2% of lung tissues were obtained by TBLB and 15.4% of them were guided by B-ultrasound guided percutaneous lung biopsy. In the local COP group, 75% of the patients were guided by B-ultrasound guided percutaneous lung biopsy, and 30% of the patients were treated with TBLB. (5) the effect of hormone therapy was good, about 16.13% of the patients had recurrence, and there was no difference between the two groups. Conclusion: the clinical manifestations of 1.COP have no obvious specificity, and the imaging features are multiple alveolar consolidation and localized consolidation. Patients with pneumonia were more likely to have symptoms such as expectoration, shortness of breath or dyspnea and fatigue, and wet rales were more common during physical examination of the lungs. 3. Glucocorticoid treatment effect is good, some patients have recurrence.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

【相似文献】