隐源性机化性肺炎10例临床病理分析
发布时间：2018-12-10 21:37
【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,旨在提高对该病的认识及诊治能力。 方法：对广西医科大学第一附属医院2002年1月1日至2012年12月31日收治的10例隐源性机化性肺炎的流行病学、临床表现、常规生化检查、肺功能检查、影像学表现、病理检查、治疗方法及预后等进行回顾性研究、分析、总结。 结果：10例患者中女性3例,占30%,男性7例,占70%,发病年龄在29-86岁之间,平均发病年龄53.30±16.10岁,所有患者均否认粉尘接触史、放射性毒物及特殊职业史,(7/10)的病例为非吸烟者。临床症状缺乏特征性,以呼吸道症状为主,表现为轻度咳嗽、咳痰、气促、胸闷、胸痛、咳血等,可伴有发热、乏力等全身症状。因临床特征不典型,白发病至确诊平均67.60±43.09天,并多伴有多种类型抗生素应用。实验室检查提示ESR、CRP升高,WBC一般不升高,肺功能表现为轻度到重度限制性通气功能障碍为主,部分呈中度到重度混合性通气功能障碍,均有弥散功能受损,血气分析提示轻度低氧血症。影像学表现主要可分为三类：斑片状实变影、弥漫性混合影、肿块影,前者多呈游走性。病理表现为肉芽结节样组织填塞肺泡腔及其他远端气腔。经糖皮质激素治疗后临床症状缓解,影像学病灶吸收、消散。 结论：隐源性机化性肺炎的诊断依据是机化性肺炎的病理诊断,在排除继发因素后,结合临床、影像学、病理学资料的综合分析而得出诊断。隐源性机化性肺炎的临床及实验室、影像学检查缺乏特异性,易误诊为肺部感染及肿瘤,抗生素治疗疗效欠佳。本病对糖皮质激素治疗反应良好,但治疗的疗程及剂量应个体化。
[Abstract]:Objective: to summarize the clinical, imaging and pathological features of cryptogenic pneumonia in order to improve the ability of diagnosis and treatment. Methods: the epidemiology, clinical manifestation, routine biochemical examination, pulmonary function examination, imaging findings and pathological examination of 10 cases of cryptogenic organized pneumonia admitted from January 1, 2002 to December 31, 2012 in the first affiliated Hospital of Guangxi Medical University were studied. The treatment methods and prognosis were retrospectively studied, analyzed and summarized. Results: among the 10 patients, 3 cases were female (30%) and 7 cases were males (70%). The onset age was between 29 and 86 years old. The average age of onset was 53.30 卤16.10 years old. All the patients denied the history of dust exposure, radioactive poison and special occupation. (seven out of 10) cases are non-smokers. The clinical symptoms were characterized by respiratory tract symptoms, such as mild cough, expectoration, shortness of breath, chest tightness, chest pain, hemoptysis and other systemic symptoms such as fever and fatigue. Because of the atypical clinical features, the average number of days from albinism to diagnosis was 67.60 卤43.09 days, and many kinds of antibiotics were used. Laboratory examination showed that ESR,CRP was elevated, but WBC was not. Pulmonary function showed mild to severe restrictive ventilation dysfunction, and partial moderate to severe mixed ventilation dysfunction. Blood gas analysis showed mild hypoxemia. The imaging findings can be divided into three types: patchy solid shadow, diffuse mixed shadow and mass shadow. The pathological findings were granulomatous tissue filling alveolar cavity and other distal air lumen. After glucocorticoid therapy, clinical symptoms were relieved, imaging focus absorbed and dissipated. Conclusion: the diagnosis of cryptogenic pneumonia is based on the pathological diagnosis. After the secondary factors are excluded, the diagnosis is obtained by combining the clinical, imaging and pathological data. The clinical and laboratory findings of cryptogenic organized pneumonia lack specificity and are easily misdiagnosed as pulmonary infection and tumor, and the therapeutic efficacy of antibiotics is poor. The response to glucocorticoid therapy is good, but the course and dosage of the treatment should be individualized.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.1
本文编号：2371236
[Abstract]:Objective: to summarize the clinical, imaging and pathological features of cryptogenic pneumonia in order to improve the ability of diagnosis and treatment. Methods: the epidemiology, clinical manifestation, routine biochemical examination, pulmonary function examination, imaging findings and pathological examination of 10 cases of cryptogenic organized pneumonia admitted from January 1, 2002 to December 31, 2012 in the first affiliated Hospital of Guangxi Medical University were studied. The treatment methods and prognosis were retrospectively studied, analyzed and summarized. Results: among the 10 patients, 3 cases were female (30%) and 7 cases were males (70%). The onset age was between 29 and 86 years old. The average age of onset was 53.30 卤16.10 years old. All the patients denied the history of dust exposure, radioactive poison and special occupation. (seven out of 10) cases are non-smokers. The clinical symptoms were characterized by respiratory tract symptoms, such as mild cough, expectoration, shortness of breath, chest tightness, chest pain, hemoptysis and other systemic symptoms such as fever and fatigue. Because of the atypical clinical features, the average number of days from albinism to diagnosis was 67.60 卤43.09 days, and many kinds of antibiotics were used. Laboratory examination showed that ESR,CRP was elevated, but WBC was not. Pulmonary function showed mild to severe restrictive ventilation dysfunction, and partial moderate to severe mixed ventilation dysfunction. Blood gas analysis showed mild hypoxemia. The imaging findings can be divided into three types: patchy solid shadow, diffuse mixed shadow and mass shadow. The pathological findings were granulomatous tissue filling alveolar cavity and other distal air lumen. After glucocorticoid therapy, clinical symptoms were relieved, imaging focus absorbed and dissipated. Conclusion: the diagnosis of cryptogenic pneumonia is based on the pathological diagnosis. After the secondary factors are excluded, the diagnosis is obtained by combining the clinical, imaging and pathological data. The clinical and laboratory findings of cryptogenic organized pneumonia lack specificity and are easily misdiagnosed as pulmonary infection and tumor, and the therapeutic efficacy of antibiotics is poor. The response to glucocorticoid therapy is good, but the course and dosage of the treatment should be individualized.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.1
【参考文献】
相关期刊论文 前1条
1 李惠萍;范峰;李秋红;赵兰;李霞;余慧;张容轩;易祥华;史景云;何国钧;;肺活检证实隐源性机化性肺炎25例临床诊治体会[J];中华结核和呼吸杂志;2007年04期
，本文编号：2371236
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