隐源性机化性肺炎的临床病例分析

发布时间：2019-03-05 20:11

【摘要】：目的:提高临床医师对隐源性机化性肺炎的综合认识水平,减少误诊、漏诊,做到早诊断、早治疗,进而减轻患者及家属的精神压力及经济负担。方法:介绍1例由山东中医药大学附属医院肺病科收治的COP病例,并检索中国知网数据库内2006年1月至2016年12月由我国文献报道的诊断明确的完整病例,对其起病形式、临床表现、辅助检查、诊断模式、治疗及疾病转归等结果进行回顾性分析。结果:共收集30例COP患者,男性16例,女性14例,吸烟4人,不吸烟26人,发病年龄22岁至81岁不等。最常见症状为咳嗽(25例),实验室检查血沉及C反应蛋白不同程度升高,肺功能以限制性通气功能障碍及弥散功能下降为主,26例患者胸部CT表现为双肺多发斑片状或片状实变影或密度增高影,内可见支气管充气征,7例患者伴发胸腔积液,部分病灶具有游走性。临床上初诊为肺炎或肺部感染26例,误诊率达100%。30例患者首次治疗均先进行过不同疗程的抗生素治疗,确诊后均给予糖皮质激素治疗,效果亦较好,4例患者出现复发,其中1例多次复发,复发前均有激素减量史或停用史。结论:COP患者男女发病无明显差异,发病年龄多在40岁-60岁,疾病发生与吸烟无明显相关性。其临床表现及辅助检查无特异性。诊断方式较独特,提倡临床-放射-病理(CRP)多学科合作诊断模式,但在临床及影像学怀疑此病可能的情况下,诊断性激素治疗对明确诊断意义亦较大,临床容易漏诊和误诊,多在抗感染治疗无效后方考虑本病可能。治疗药物以糖皮质激素为主,大环内脂类药物治疗亦有效,部分患者可复发,复发与激素不规范应用(减量或者停药等)有关。
[Abstract]:Aim: to improve the comprehensive understanding of cryptogenic organizing pneumonia, reduce misdiagnosis, missed diagnosis, early diagnosis and early treatment, and reduce the mental pressure and economic burden of patients and their families. Methods: a case of COP from the Department of Lung Disease, affiliated Hospital of Shandong University of traditional Chinese Medicine was introduced, and a complete case with definite diagnosis reported by Chinese literature from January 2006 to December 2016 was searched in the database of China knowledge Network, and the form of onset of the case was analyzed. The clinical manifestation, auxiliary examination, diagnosis model, treatment and disease outcome were analyzed retrospectively. Results: a total of 30 patients with COP were collected, including 16 males, 14 females, 4 smokers and 26 non-smokers. The age of onset ranged from 22 to 81 years old. The most common symptoms were cough (25 cases). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased in different degrees in laboratory examination. The pulmonary function was mainly restricted ventilation dysfunction and decreased diffusion function. In 26 cases, chest CT showed multiple patchy or flake consolidation or hyperdense lesions in both lungs, bronchial inflatable sign could be seen in 7 cases, pleural effusion was associated in 7 cases, and some lesions were wandering. 26 cases were initially diagnosed as pneumonia or pulmonary infection, and the misdiagnosis rate was 100%. All 30 cases were treated with different courses of antibiotics in the first treatment, and all the patients were treated with glucocorticoid after the diagnosis, and the effect was also good. 4 cases recurred, and the rate of misdiagnosis was 100% in the first time, and the rate of misdiagnosis was 100% in 30 cases of the first treatment. One of them recurred many times and all had a history of hormone reduction or withdrawal before recurrence. Conclusion: there is no significant difference in the incidence of COP between male and female, and the age of onset is mostly 40-60 years old. There is no significant correlation between the occurrence of the disease and smoking. There was no specificity in clinical manifestation and auxiliary examination. The method of diagnosis is unique, and the multi-disciplinary cooperative diagnosis model of clinical-radiological-pathological (CRP) is advocated. However, in the case of clinical and imaging suspicion of this disease, the diagnosis of sex hormone therapy is also of great significance for definite diagnosis. Clinical missed diagnosis and misdiagnosis, most of the anti-infection treatment after ineffective consideration of this disease. The treatment drugs are mainly glucocorticoids, and macrocyclic lipid drugs are also effective. Some patients can recur, and the recurrence is related to the irregular use of hormones (reduction or withdrawal of drugs, etc.).
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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