【摘要】：目的:總結(jié)隱源性機(jī)化性肺炎的臨床、影像學(xué)、病理學(xué)等特點(diǎn),比較隱源性機(jī)化性肺炎不同亞型之間在臨床表現(xiàn)、炎癥指標(biāo)、肺功能等方面的差異,旨在提高對(duì)隱源性機(jī)化性肺炎不同亞型的認(rèn)識(shí)及診治能力。方法:對(duì)廣西醫(yī)科大學(xué)第一附屬醫(yī)院2012年3月至2017年3月收治的經(jīng)病理確診的44例隱源性機(jī)化性肺炎的臨床表現(xiàn)、炎癥指標(biāo)、肺功能、影像學(xué)表現(xiàn)、活檢方式以及治療方法、預(yù)后等臨床資料進(jìn)行回顧性分析,根據(jù)不同的影像學(xué)表現(xiàn)分組,比較不同組別之間的差異。結(jié)果:在44例隱源性機(jī)化性肺炎患者中,男性26例,占總體的59.09%,女性18例,占40.91%,平均發(fā)病年齡為54.77±13.81歲。根據(jù)影像學(xué)特點(diǎn)分為肺炎型COP組(24例)、局灶型COP組(20例)。(1)臨床表現(xiàn):病程多在2-12周,主要為咳嗽(88.64%)、咳痰(65.91%)、胸痛(34.09%)、氣促或呼吸困難(27.27%)、咳血(13.64%)、胸悶(9.09%)、伴有發(fā)熱(50%)、畏寒(9.09%)、乏力(9.09%)等癥狀。31.81%患者中聞及濕羅音,肺炎型COP組較局灶型COP出現(xiàn)濕羅音的例數(shù)多。(2)炎癥指標(biāo):28例白細(xì)胞計(jì)數(shù)正常,占63.64%,32例中性粒細(xì)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組:白細(xì)胞計(jì)數(shù)為9.15±3.85×109/L,中性粒細(xì)胞百分比0.72±0.11%,C-反應(yīng)蛋白29.41±89.58g/L,血沉51.83±31.31mm。局灶型COP組:白細(xì)胞計(jì)數(shù)為7.46±4.49×109/L,中性粒細(xì)胞百分比0.62±0.10%,C-反應(yīng)蛋白12.26±34.26g/L,血沉35.45±24.49mm。(3)肺功能檢查:25%彌散功能正常,75%不同程度的彌散功能障礙(輕度25%,輕中度10.71%,中度32.14%,重度7.14%);35.71%通氣功能正常,28.57%表現(xiàn)為混合性通氣功能障礙,25%表現(xiàn)為阻塞性通氣功能障礙,25%為限制性通氣功能障礙。肺炎型COP組彌散功能較局灶型差。(4)經(jīng)TBLB獲取肺組織確診者占56.82%,B超引導(dǎo)下經(jīng)皮肺活檢者占52.27%,外科手術(shù)占4.54%,經(jīng)胸腔鏡下獲取肺組織占4.54%。肺炎型COP組采取TBLB方式獲取肺組織者占79.2%,采用B超引導(dǎo)下經(jīng)皮肺活檢方法者只占15.4%。局灶型COP組采用B超引導(dǎo)下經(jīng)皮肺活檢的占75%,采用TBLB者占30%。(5)激素治療效果好,約16.13%出現(xiàn)復(fù)發(fā),兩組間無(wú)差異。結(jié)論:1.COP臨床表現(xiàn)無(wú)明顯特異性,影像學(xué)多表現(xiàn)為多發(fā)的肺泡實(shí)變影以及局限性的實(shí)變影。2.影像學(xué)表現(xiàn)為肺炎型的患者更易出現(xiàn)咳痰、氣促或呼吸困難、乏力等癥狀,肺部查體時(shí)濕羅音亦更常見(jiàn)。3.糖皮質(zhì)激素治療效果好,部分患者有復(fù)發(fā)。
[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 鹵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 鹵3.85 脳 109 mL, neutrophil percentage 0.72 鹵0.11%, C-reactive protein 29.41 鹵89.58 g / L, erythrocyte sedimentation rate 51.83 鹵31.31 mm. In focal COP group, leukocyte count was 7.46 鹵4.49 脳 109 mL, neutrophil percentage 0.62 鹵0.10%, C-reactive protein 12.26 鹵34.26 g / L, ESR 35.45 鹵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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R563.1

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