【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),旨在提高對(duì)該病的認(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2002年1月1日至2012年12月31日收治的10例隱源性機(jī)化性肺炎的流行病學(xué)、臨床表現(xiàn)、常規(guī)生化檢查、肺功能檢查、影像學(xué)表現(xiàn)、病理檢查、治療方法及預(yù)后等進(jìn)行回顧性研究、分析、總結(jié)。 結(jié)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(rèn)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(xiàn)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(yīng)用。實(shí)驗(yàn)室檢查提示ESR、CRP升高,WBC一般不升高,肺功能表現(xiàn)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?dú)夥治鎏崾据p度低氧血癥。影像學(xué)表現(xiàn)主要可分為三類：斑片狀實(shí)變影、彌漫性混合影、腫塊影,前者多呈游走性。病理表現(xiàn)為肉芽結(jié)節(jié)樣組織填塞肺泡腔及其他遠(yuǎn)端氣腔。經(jīng)糖皮質(zhì)激素治療后臨床癥狀緩解,影像學(xué)病灶吸收、消散。 結(jié)論：隱源性機(jī)化性肺炎的診斷依據(jù)是機(jī)化性肺炎的病理診斷,在排除繼發(fā)因素后,結(jié)合臨床、影像學(xué)、病理學(xué)資料的綜合分析而得出診斷。隱源性機(jī)化性肺炎的臨床及實(shí)驗(yàn)室、影像學(xué)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(duì)糖皮質(zhì)激素治療反應(yīng)良好,但治療的療程及劑量應(yīng)個(gè)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(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】：2013
【分類號(hào)】：R563.1

【參考文獻(xiàn)】

相關(guān)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(shí)隱源性機(jī)化性肺炎25例臨床診治體會(huì)[J];中華結(jié)核和呼吸雜志;2007年04期

，

本文編號(hào)：2371236