隱源性機化性肺炎10例臨床病理分析
發(fā)布時間：2018-12-10 21:37
【摘要】：目的：總結隱源性機化性肺炎的臨床、影像學、病理學等特點,旨在提高對該病的認識及診治能力。 方法：對廣西醫(yī)科大學第一附屬醫(yī)院2002年1月1日至2012年12月31日收治的10例隱源性機化性肺炎的流行病學、臨床表現、常規(guī)生化檢查、肺功能檢查、影像學表現、病理檢查、治療方法及預后等進行回顧性研究、分析、總結。 結果：10例患者中女性3例,占30%,男性7例,占70%,發(fā)病年齡在29-86歲之間,平均發(fā)病年齡53.30±16.10歲,所有患者均否認粉塵接觸史、放射性毒物及特殊職業(yè)史,(7/10)的病例為非吸煙者。臨床癥狀缺乏特征性,以呼吸道癥狀為主,表現為輕度咳嗽、咳痰、氣促、胸悶、胸痛、咳血等,可伴有發(fā)熱、乏力等全身癥狀。因臨床特征不典型,白發(fā)病至確診平均67.60±43.09天,并多伴有多種類型抗生素應用。實驗室檢查提示ESR、CRP升高,WBC一般不升高,肺功能表現為輕度到重度限制性通氣功能障礙為主,部分呈中度到重度混合性通氣功能障礙,均有彌散功能受損,血氣分析提示輕度低氧血癥。影像學表現主要可分為三類：斑片狀實變影、彌漫性混合影、腫塊影,前者多呈游走性。病理表現為肉芽結節(jié)樣組織填塞肺泡腔及其他遠端氣腔。經糖皮質激素治療后臨床癥狀緩解,影像學病灶吸收、消散。 結論：隱源性機化性肺炎的診斷依據是機化性肺炎的病理診斷,在排除繼發(fā)因素后,結合臨床、影像學、病理學資料的綜合分析而得出診斷。隱源性機化性肺炎的臨床及實驗室、影像學檢查缺乏特異性,易誤診為肺部感染及腫瘤,抗生素治療療效欠佳。本病對糖皮質激素治療反應良好,但治療的療程及劑量應個體化。
[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 鹵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 鹵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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R563.1
本文編號：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 鹵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 鹵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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R563.1
【參考文獻】
相關期刊論文 前1條
1 李惠萍;范峰;李秋紅;趙蘭;李霞;余慧;張容軒;易祥華;史景云;何國鈞;;肺活檢證實隱源性機化性肺炎25例臨床診治體會[J];中華結核和呼吸雜志;2007年04期
，本文編號：2371236
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