5例闭塞性细支气管炎伴机化性肺炎（BOOP）的临床分析并文献复习

发布时间：2018-03-06 14:01

本文选题：闭塞性细支气管炎伴机化性肺炎　切入点：隐源性机化性肺炎　出处：《广西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：闭塞性细支气管炎伴机化性肺炎(Bronchiolitisobliterans with organizing pneumonia BOOP)是独特的临床病理综合征,可分为原因不明的隐源性机化性肺炎(cryptogenic organizing pneumonia COP)和继发性机化性肺炎。本文通过回顾性分析病理诊断为闭塞性细支气管炎伴机化性肺炎的5例患者的病因、临床表现、病理和影像学特征,为提高临床诊断和治疗该病的水平做一些参考。方法：调查我院2004-2011年在我院住院,经病理确诊为闭塞性细支气管炎伴机化性肺炎患者5例,(其中1例为2009年确诊,其余均为2011年确诊病例),其中2例经皮肺活检,2例经支气管镜肺活检(transbronchial lung biopsy TBLB),1例经电视胸腔镜肺手术(Video-assisted thoracoscopic lung surgeryVATS)取得肺组织并经病理确诊。对其病因、临床表现、影像、病理特点和诊疗进行了综合分析。结果：(1)5例经病理诊断为BOOP患者中,4例为不明原因的特发性BOOP,但其中1例治疗后随访1年,症状再发,诊断为肺癌；另1例可能继发于感染。(2)5例患者中男3例,女2例,3例男性患者均有吸烟史,年龄(29-71)岁,病程为(1-24)月,主要临床表现有发热、咳嗽、胸闷、气促、消瘦和肺部VelcroUp音或湿Up音。(3)4例患者有肺功能检查结果,其中1例肺功能未见异常,另3例患者均有弥散性通气功能障碍,其中2例合并限制性通气障碍,1例合并混合性通气功能障碍。4例患者有单纯低氧血症。(4)5例患者的白细胞正常或轻度偏高,其中2例外周血嗜酸细胞所占百分比稍增高,分别为11.4%和8.3%。所有患者血沉增快(53-77mm/h)。(5)影像学表现：1例可见弥漫性磨玻璃样及斑片状致密影；1例为粟粒状及小结节状致密影；3例患者为单发大片致密阴影或斑片状密度增高影。(6)治疗及转归：3例患者给予口服强的松治疗并维持6个月,病情缓解,其中2例随访至今未复发；另1例一年后症状再发,经病理诊断为肺低分化腺鳞癌,已给予化疗,目前发现癌细胞已转移至肝脏。1例给予抗生素治疗,患者症状明显好转,随访至今未复发。1例经手术切除病变肺组织,未作其他治疗,现已失访。(7)5例患者中有3例临床诊断与病理诊断有差异,分别诊断为炎性假瘤、嗜酸细胞性肺炎、两肺炎。所有患者诊断之前均给予抗生素治疗2-4周,其中1例曾给予抗结核治疗一个月。结论：闭塞性细支气管炎伴机化性肺炎(BOOP)是一个病理诊断,临床上可划分为隐源性机化性肺炎和继发性机化性肺炎,但其临床表现和影像学表现没有明显的特异性,继发性者寻找根本的病因很重要。到目前为止尚无明确的诊断标准,确诊有赖病理学检查,临床容易误诊及漏诊。激素治疗有效,但继发性者预后与原发病有关。治疗后随访也很重要,有助于了解该病的复发率和治愈率。
[Abstract]:Objective: bronchiolitis obliterans with organizing pneumonia BOOPP is a unique clinicopathological syndrome. It can be divided into cryptogenic organizing pneumonia CPP and secondary organopneumonia. The etiology and clinical manifestations of 5 patients with bronchiolitis obliterans complicated with organopneumonia were analyzed retrospectively. Pathological and imaging features, to improve the level of clinical diagnosis and treatment of the disease to do some reference. Methods: a survey of our hospital from 2004 to 2011 in our hospital, Five patients with bronchiolitis obliterans complicated with organopneumonia were diagnosed by pathology (one of them was diagnosed in 2009). The rest were confirmed in 2011, 2 of them were transbronchial lung biopsy TBLBATSs, 2 were transbronchial lung biopsy TBLBATSs, 1 was video-assisted thoracoscopic lung surrey VATSs (video-assisted thoracoscopic lung SurgeryVATSs), and the pathogeny, clinical manifestations and imaging were analyzed. Results among the 5 cases of BOOP diagnosed by pathology, 4 cases were idiopathic BOOPs with unknown cause, but one case was followed up for 1 year after treatment, the symptom recrudesced and was diagnosed as lung cancer. The other one was probably secondary to infection. There were 3 males and 2 females with smoking history, aged 29-71). The course of disease was 1-24 months. The main clinical manifestations were fever, cough, chest tightness, shortness of breath. Pulmonary function examination was found in 4 patients with wasting and lung VelcroUp or wet up tone, including 1 case with no abnormal pulmonary function and 3 cases with diffusive ventilatory dysfunction. Among them, 2 cases were complicated with restrictive ventilation disorder and 1 case with mixed ventilation dysfunction. 4 cases had simple hypoxemia. 5 cases had normal white blood cells or slight hypertrophy, and 2 cases had higher percentage of peripheral blood eosinophils. 11.4% and 8.3, respectively. All patients had rapid ESR of 53-77mm / min 路min ~ (5) Imaging findings: 1 case showed diffuse ground glass and 1 case had a miliary or small nodular dense shadow. 3 cases had a single large dense shadow or flake dense spot. Three patients were treated with oral prednisone for 6 months. The disease was relieved, two of them had not recurred so far after follow-up, and the other one had a recurrence of symptoms after one year and was diagnosed by pathology as poorly differentiated adenosquamous carcinoma of the lung, which had been given chemotherapy. At present, it was found that the cancer cells had metastasized to the liver in .1 cases and were treated with antibiotics. The symptoms of the patients were obviously improved. There was no recurrence of 1 cases of lung tissues resected by operation and no other treatment. There were 3 cases of clinical diagnosis and pathological diagnosis of inflammatory pseudotumor diagnosed as inflammatory pseudotumor. All patients were treated with antibiotics for 2-4 weeks before diagnosis, and one patient had been treated with anti-tuberculosis for one month. Conclusion: bronchiolitis obliterans with organopneumonia is a pathological diagnosis. Clinically, it can be divided into cryptogenic pneumonia and secondary organopneumonia, but its clinical and imaging manifestations have no obvious specificity. It is very important for secondary patients to find the underlying etiology. So far, there is no clear diagnostic standard. The diagnosis depends on pathological examination. It is easy to misdiagnose and miss diagnosis clinically. Hormone therapy is effective, but the prognosis of secondary patients is related to the primary disease. The follow-up after treatment is also very important, which is helpful to understand the recurrence rate and cure rate of the disease.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.1

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