纤维支气管镜在隐源性机化性肺炎诊治中的价值

发布时间：2019-06-02 16:00

【摘要】：目的探讨纤维支气管镜在隐源性机化性肺炎(COP)诊断及治疗过程中的价值。方法回顾性分析2008年~2012年该院住院,经纤维支气管肺组织活检(TBLB)取得病理依据,根据最终确诊为隐源性机化性肺炎6例患者的临床资料,总结COP的临床特征及纤维支气管镜应用经验。结果 6例隐源性机化性肺炎患者平均年龄为(52.5±12)岁,平均发病时间为2.5个月,临床表现为咳嗽、咳痰、劳力性气促及发热等,4例可闻及湿Up音,无杵状指。5例患者白细胞正常,1例增高,5例血沉以及C反应蛋白增高,2例有低氧血症,4例为限制性通气功能障碍,5例有弥散功能障碍。影像学主要表现为双下肺斑片状高密度影,伴有条索状影、支气管充气征和空洞等,未见蜂窝样影。肺组织病理病变形态呈阻塞性细支气管炎并机化性肺炎改变,所有患者仅需单次TBLB确诊,过程简单无并发症。6例患者均口服糖皮质激素治疗而痊愈,随访2年无复发。结论 COP常误诊肺部炎症,但抗感染无效,肺部影像学表现为多样性的实质、间质改变,确诊需要病理依据,TBLB操作简单、并发症少、阳性率高、可重复性及可作为首选有创检查。糖皮质激素治疗效果佳,预后好。
[Abstract]:Objective to evaluate the value of fiberoptic bronchoscopy in the diagnosis and treatment of cryptogenic organic pneumonia (COP). Methods from 2008 to 2012, the pathological data of 6 patients with cryptogenic organic pneumonia were analyzed retrospectively. the pathological basis was obtained by (TBLB) of fiberoptic broncholung tissue biopsy. according to the clinical data of 6 patients with cryptogenic organic pneumonia. The clinical features of COP and the experience of fiberoptic bronchoscopy were summarized. Results the average age of 6 patients with cryptogenic organic pneumonia was (52.5 卤12) years, and the average onset time was 2.5 months. The clinical manifestations were cough, expectoration, fatigue shortness of breath and fever. Wet Up sound could be detected in 4 cases. There was no pestle finger. In 5 cases, leukocytes were normal, 1 case was elevated, 5 cases were erythrocyte sedimentation rate and C-reactive protein increased, 2 cases had hypoxia, 4 cases had restricted ventilation dysfunction, 5 cases had diffusion dysfunction. The imaging findings were patchy high density shadow of double inferior lung, accompanied by strip shadow, bronchial inflatable sign and cavity, and no honeycomb shadow was found. The pathological changes of lung tissue were obstructive bronchiolitis complicated with organic pneumonia. All patients were diagnosed by single TBLB with no complications. Six patients were cured by oral glucocorticoid therapy and no recurrence was found after 2 years follow-up. Conclusion COP is often misdiagnosed as pulmonary inflammation, but the anti-infection is ineffective. The imaging findings of the lung are diverse essence, stroma changes, the diagnosis needs pathological basis, the operation of TBLB is simple, the complications are few, and the positive rate is high. Reproducibility and can be used as the first choice invasive examination. Glucocorticoid has good therapeutic effect and good prognosis.
【作者单位】：广西医科大学第一附属医院呼吸科;
【分类号】：R563.1

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