隱源性機(jī)化性肺炎的臨床病例分析
發(fā)布時(shí)間：2019-03-05 20:11
【摘要】：目的:提高臨床醫(yī)師對(duì)隱源性機(jī)化性肺炎的綜合認(rèn)識(shí)水平,減少誤診、漏診,做到早診斷、早治療,進(jìn)而減輕患者及家屬的精神壓力及經(jīng)濟(jì)負(fù)擔(dān)。方法:介紹1例由山東中醫(yī)藥大學(xué)附屬醫(yī)院肺病科收治的COP病例,并檢索中國(guó)知網(wǎng)數(shù)據(jù)庫(kù)內(nèi)2006年1月至2016年12月由我國(guó)文獻(xiàn)報(bào)道的診斷明確的完整病例,對(duì)其起病形式、臨床表現(xiàn)、輔助檢查、診斷模式、治療及疾病轉(zhuǎn)歸等結(jié)果進(jìn)行回顧性分析。結(jié)果:共收集30例COP患者,男性16例,女性14例,吸煙4人,不吸煙26人,發(fā)病年齡22歲至81歲不等。最常見(jiàn)癥狀為咳嗽(25例),實(shí)驗(yàn)室檢查血沉及C反應(yīng)蛋白不同程度升高,肺功能以限制性通氣功能障礙及彌散功能下降為主,26例患者胸部CT表現(xiàn)為雙肺多發(fā)斑片狀或片狀實(shí)變影或密度增高影,內(nèi)可見(jiàn)支氣管充氣征,7例患者伴發(fā)胸腔積液,部分病灶具有游走性。臨床上初診為肺炎或肺部感染26例,誤診率達(dá)100%。30例患者首次治療均先進(jìn)行過(guò)不同療程的抗生素治療,確診后均給予糖皮質(zhì)激素治療,效果亦較好,4例患者出現(xiàn)復(fù)發(fā),其中1例多次復(fù)發(fā),復(fù)發(fā)前均有激素減量史或停用史。結(jié)論:COP患者男女發(fā)病無(wú)明顯差異,發(fā)病年齡多在40歲-60歲,疾病發(fā)生與吸煙無(wú)明顯相關(guān)性。其臨床表現(xiàn)及輔助檢查無(wú)特異性。診斷方式較獨(dú)特,提倡臨床-放射-病理(CRP)多學(xué)科合作診斷模式,但在臨床及影像學(xué)懷疑此病可能的情況下,診斷性激素治療對(duì)明確診斷意義亦較大,臨床容易漏診和誤診,多在抗感染治療無(wú)效后方考慮本病可能。治療藥物以糖皮質(zhì)激素為主,大環(huán)內(nèi)脂類藥物治療亦有效,部分患者可復(fù)發(fā),復(fù)發(fā)與激素不規(guī)范應(yīng)用(減量或者停藥等)有關(guān)。
[Abstract]:Aim: to improve the comprehensive understanding of cryptogenic organizing pneumonia, reduce misdiagnosis, missed diagnosis, early diagnosis and early treatment, and reduce the mental pressure and economic burden of patients and their families. Methods: a case of COP from the Department of Lung Disease, affiliated Hospital of Shandong University of traditional Chinese Medicine was introduced, and a complete case with definite diagnosis reported by Chinese literature from January 2006 to December 2016 was searched in the database of China knowledge Network, and the form of onset of the case was analyzed. The clinical manifestation, auxiliary examination, diagnosis model, treatment and disease outcome were analyzed retrospectively. Results: a total of 30 patients with COP were collected, including 16 males, 14 females, 4 smokers and 26 non-smokers. The age of onset ranged from 22 to 81 years old. The most common symptoms were cough (25 cases). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased in different degrees in laboratory examination. The pulmonary function was mainly restricted ventilation dysfunction and decreased diffusion function. In 26 cases, chest CT showed multiple patchy or flake consolidation or hyperdense lesions in both lungs, bronchial inflatable sign could be seen in 7 cases, pleural effusion was associated in 7 cases, and some lesions were wandering. 26 cases were initially diagnosed as pneumonia or pulmonary infection, and the misdiagnosis rate was 100%. All 30 cases were treated with different courses of antibiotics in the first treatment, and all the patients were treated with glucocorticoid after the diagnosis, and the effect was also good. 4 cases recurred, and the rate of misdiagnosis was 100% in the first time, and the rate of misdiagnosis was 100% in 30 cases of the first treatment. One of them recurred many times and all had a history of hormone reduction or withdrawal before recurrence. Conclusion: there is no significant difference in the incidence of COP between male and female, and the age of onset is mostly 40-60 years old. There is no significant correlation between the occurrence of the disease and smoking. There was no specificity in clinical manifestation and auxiliary examination. The method of diagnosis is unique, and the multi-disciplinary cooperative diagnosis model of clinical-radiological-pathological (CRP) is advocated. However, in the case of clinical and imaging suspicion of this disease, the diagnosis of sex hormone therapy is also of great significance for definite diagnosis. Clinical missed diagnosis and misdiagnosis, most of the anti-infection treatment after ineffective consideration of this disease. The treatment drugs are mainly glucocorticoids, and macrocyclic lipid drugs are also effective. Some patients can recur, and the recurrence is related to the irregular use of hormones (reduction or withdrawal of drugs, etc.).
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.1
本文編號(hào)：2435245
[Abstract]:Aim: to improve the comprehensive understanding of cryptogenic organizing pneumonia, reduce misdiagnosis, missed diagnosis, early diagnosis and early treatment, and reduce the mental pressure and economic burden of patients and their families. Methods: a case of COP from the Department of Lung Disease, affiliated Hospital of Shandong University of traditional Chinese Medicine was introduced, and a complete case with definite diagnosis reported by Chinese literature from January 2006 to December 2016 was searched in the database of China knowledge Network, and the form of onset of the case was analyzed. The clinical manifestation, auxiliary examination, diagnosis model, treatment and disease outcome were analyzed retrospectively. Results: a total of 30 patients with COP were collected, including 16 males, 14 females, 4 smokers and 26 non-smokers. The age of onset ranged from 22 to 81 years old. The most common symptoms were cough (25 cases). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased in different degrees in laboratory examination. The pulmonary function was mainly restricted ventilation dysfunction and decreased diffusion function. In 26 cases, chest CT showed multiple patchy or flake consolidation or hyperdense lesions in both lungs, bronchial inflatable sign could be seen in 7 cases, pleural effusion was associated in 7 cases, and some lesions were wandering. 26 cases were initially diagnosed as pneumonia or pulmonary infection, and the misdiagnosis rate was 100%. All 30 cases were treated with different courses of antibiotics in the first treatment, and all the patients were treated with glucocorticoid after the diagnosis, and the effect was also good. 4 cases recurred, and the rate of misdiagnosis was 100% in the first time, and the rate of misdiagnosis was 100% in 30 cases of the first treatment. One of them recurred many times and all had a history of hormone reduction or withdrawal before recurrence. Conclusion: there is no significant difference in the incidence of COP between male and female, and the age of onset is mostly 40-60 years old. There is no significant correlation between the occurrence of the disease and smoking. There was no specificity in clinical manifestation and auxiliary examination. The method of diagnosis is unique, and the multi-disciplinary cooperative diagnosis model of clinical-radiological-pathological (CRP) is advocated. However, in the case of clinical and imaging suspicion of this disease, the diagnosis of sex hormone therapy is also of great significance for definite diagnosis. Clinical missed diagnosis and misdiagnosis, most of the anti-infection treatment after ineffective consideration of this disease. The treatment drugs are mainly glucocorticoids, and macrocyclic lipid drugs are also effective. Some patients can recur, and the recurrence is related to the irregular use of hormones (reduction or withdrawal of drugs, etc.).
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 丁群力;呂丹;王碧炯;張巧麗;虞亦鳴;鄧在春;;大環(huán)內(nèi)酯類藥物治療隱源性機(jī)化性肺炎一例并文獻(xiàn)復(fù)習(xí)[J];中國(guó)全科醫(yī)學(xué);2014年32期
2 許白蘭;;隱源性機(jī)化性肺炎的肺部CT及病理特征分析[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2014年19期
3 佟淑平;杜聞博;呂福云;于影;楊焱;;隱源性機(jī)化性肺炎的研究進(jìn)展*[J];臨床急診雜志;2013年05期
4 高澤林;張曉斌;;隱源性機(jī)化性肺炎臨床診治23例[J];陜西醫(yī)學(xué)雜志;2013年03期
5 梁起芳;李瑞香;;隱源性機(jī)化性肺炎15例臨床分析[J];中國(guó)當(dāng)代醫(yī)藥;2012年08期
6 曲寶戈;竇學(xué)榮;蘇吉亮;劉新風(fēng);李茂月;王平;;國(guó)內(nèi)隱源性機(jī)化性肺炎115例分析[J];現(xiàn)代診斷與治療;2011年04期
7 范家珊;陸莎;李有霞;;兩種組織活檢術(shù)在肺部塊影鑒別診斷中的對(duì)比性分析[J];臨床肺科雜志;2011年07期
8 陳彬;趙峰;何健;章士正;;隱源性機(jī)化性肺炎的CT征象分析[J];中華放射學(xué)雜志;2011年06期
9 周艷;趙弘卿;;隱源性機(jī)化性肺炎的診治進(jìn)展[J];中國(guó)呼吸與危重監(jiān)護(hù)雜志;2011年01期
10 陳海紅;李華茵;盧韶華;何禮賢;;隱源性機(jī)化性肺炎的臨床分析[J];中國(guó)臨床醫(yī)學(xué);2010年02期
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