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目的分析25例经肺活检确诊的隐源性机化性肺炎(COP)患者的临床资料,总结COP 的临床、影像学、病理学、转归与预后等特点,以指导临床实践。方法收集2000年1月至2006年4月期间经肺活检证实的25例 COP 患者的所有资料,对其易患因素、临床表现、影像学表现、病理改变、常规生化检查等进行统计学处理和综合分析。主要治疗方法为糖皮质激素(简称激素)静脉滴注和口服序贯疗法。结果 25例中男6例,女19例,男:女为1:3.17;年龄40～73岁,平均(56±9)岁;起病到确诊时间为1～241个月,平均>16个月,中位数为3个月;随访时间为2～71个月,中位数为22个月。近半数患者有药物过敏史、各种工业粉尘和植物粉尘接触史;与吸烟的关系不甚密切。临床症状缺乏特征性,主要为咳嗽、气促等呼吸系统症状,少数有低热、盗汗、乏力等全身症状。影像学表现具有“五多一少”的特点(多态性、多发性、多变性、多复发性、多双肺受累,蜂窝肺少见)。肺功能表现为轻度通气功能障碍,残气容积增加,弥散功能受损。19例完全治愈,但有8例复发;其余6例均有不同程度的好转,但有1例急性加重。复发多发生在1年半至2年间激素停药或减量至5～10mg/d 时。治愈后复发病例的激素用药时间[(19±6)个月]明显短于未复发者[(29±12)]个月。结论 COP 在我国并非少见。基于临床、影像学、病理学资料的综合分析是最重要的诊断方法。激素为首选治疗用药,其中静脉滴注和口服序贯疗法具有起效快、不良反应小和依从性好等优点。本病预后良好,但复发率较高。
Objective To analyze the clinical data of 25 patients with cryptogenic organic pneumonia (COP) diagnosed by pulmonary biopsy and summarize the clinical, radiological, pathological, prognostic and prognosis characteristics of COP so as to guide clinical practice. Methods All data of 25 patients with COP confirmed by lung biopsy from January 2000 to April 2006 were collected and their susceptibility factors, clinical manifestations, imaging findings, pathological changes and routine biochemical tests were statistically analyzed. Comprehensive analysis. The main treatment for glucocorticoid (referred to as hormone) intravenous drip and oral sequential therapy. Results There were 6 males and 19 females in 25 cases, with a male to female ratio of 1 to 3.17. The average age was 40 to 73 years old (56 ± 9) years. The time from onset to diagnosis was 1 to 241 months with an average of 16 Month, the median was 3 months; the follow-up time was 2 to 71 months with a median of 22 months. Nearly half of patients had a history of drug allergies, a history of industrial dust and plant dust exposure, and the relationship with smoking was not very close. The lack of clinical features of the symptoms, mainly cough, shortness of breath and other respiratory symptoms, a few have low fever, night sweats, fatigue and other systemic symptoms. Imaging features with “more than one less” features (polymorphism, multiple, variability, multiple recurrent, multiple lung involvement, rare in cellular lung). Pulmonary function showed mild ventilation dysfunction, increased residual volume, diffuse dysfunction. 19 cases were completely cured, but 8 cases relapsed; the remaining 6 cases have varying degrees of improvement, but 1 case of acute exacerbation. Recurrence occurred in 1 year and a half to 2 years hormone withdrawal or reduction to 5 ~ 10mg / d. The hormonal duration of treatment for relapsed cases was significantly shorter ([19 ± 6] months) than for those who did not ([29 ± 12] months]. Conclusion COP is not uncommon in our country. Comprehensive analysis based on clinical, imaging, and pathological data is the most important diagnostic method. Hormone is the treatment of choice, including intravenous infusion and oral sequential therapy with rapid onset, adverse reactions and good compliance and so on. The disease prognosis is good, but the recurrence rate is higher.