本文選題：閉塞性細(xì)支氣管炎伴機(jī)化性肺炎　切入點(diǎn)：隱源性機(jī)化性肺炎　出處：《廣西醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：閉塞性細(xì)支氣管炎伴機(jī)化性肺炎(Bronchiolitisobliterans with organizing pneumonia BOOP)是獨(dú)特的臨床病理綜合征,可分為原因不明的隱源性機(jī)化性肺炎(cryptogenic organizing pneumonia COP)和繼發(fā)性機(jī)化性肺炎。本文通過(guò)回顧性分析病理診斷為閉塞性細(xì)支氣管炎伴機(jī)化性肺炎的5例患者的病因、臨床表現(xiàn)、病理和影像學(xué)特征,為提高臨床診斷和治療該病的水平做一些參考。方法：調(diào)查我院2004-2011年在我院住院,經(jīng)病理確診為閉塞性細(xì)支氣管炎伴機(jī)化性肺炎患者5例,(其中1例為2009年確診,其余均為2011年確診病例),其中2例經(jīng)皮肺活檢,2例經(jīng)支氣管鏡肺活檢(transbronchial lung biopsy TBLB),1例經(jīng)電視胸腔鏡肺手術(shù)(Video-assisted thoracoscopic lung surgeryVATS)取得肺組織并經(jīng)病理確診。對(duì)其病因、臨床表現(xiàn)、影像、病理特點(diǎn)和診療進(jìn)行了綜合分析。結(jié)果：(1)5例經(jīng)病理診斷為BOOP患者中,4例為不明原因的特發(fā)性BOOP,但其中1例治療后隨訪1年,癥狀再發(fā),診斷為肺癌；另1例可能繼發(fā)于感染。(2)5例患者中男3例,女2例,3例男性患者均有吸煙史,年齡(29-71)歲,病程為(1-24)月,主要臨床表現(xiàn)有發(fā)熱、咳嗽、胸悶、氣促、消瘦和肺部VelcroUp音或濕Up音。(3)4例患者有肺功能檢查結(jié)果,其中1例肺功能未見(jiàn)異常,另3例患者均有彌散性通氣功能障礙,其中2例合并限制性通氣障礙,1例合并混合性通氣功能障礙。4例患者有單純低氧血癥。(4)5例患者的白細(xì)胞正常或輕度偏高,其中2例外周血嗜酸細(xì)胞所占百分比稍增高,分別為11.4%和8.3%。所有患者血沉增快(53-77mm/h)。(5)影像學(xué)表現(xiàn)：1例可見(jiàn)彌漫性磨玻璃樣及斑片狀致密影；1例為粟粒狀及小結(jié)節(jié)狀致密影；3例患者為單發(fā)大片致密陰影或斑片狀密度增高影。(6)治療及轉(zhuǎn)歸：3例患者給予口服強(qiáng)的松治療并維持6個(gè)月,病情緩解,其中2例隨訪至今未復(fù)發(fā)；另1例一年后癥狀再發(fā),經(jīng)病理診斷為肺低分化腺鱗癌,已給予化療,目前發(fā)現(xiàn)癌細(xì)胞已轉(zhuǎn)移至肝臟。1例給予抗生素治療,患者癥狀明顯好轉(zhuǎn),隨訪至今未復(fù)發(fā)。1例經(jīng)手術(shù)切除病變肺組織,未作其他治療,現(xiàn)已失訪。(7)5例患者中有3例臨床診斷與病理診斷有差異,分別診斷為炎性假瘤、嗜酸細(xì)胞性肺炎、兩肺炎。所有患者診斷之前均給予抗生素治療2-4周,其中1例曾給予抗結(jié)核治療一個(gè)月。結(jié)論：閉塞性細(xì)支氣管炎伴機(jī)化性肺炎(BOOP)是一個(gè)病理診斷,臨床上可劃分為隱源性機(jī)化性肺炎和繼發(fā)性機(jī)化性肺炎,但其臨床表現(xiàn)和影像學(xué)表現(xiàn)沒(méi)有明顯的特異性,繼發(fā)性者尋找根本的病因很重要。到目前為止尚無(wú)明確的診斷標(biāo)準(zhǔn),確診有賴病理學(xué)檢查,臨床容易誤診及漏診。激素治療有效,但繼發(fā)性者預(yù)后與原發(fā)病有關(guān)。治療后隨訪也很重要,有助于了解該病的復(fù)發(fā)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.
【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】：2012
【分類號(hào)】：R563.1

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