隱源性機化性肺炎的臨床特點分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

馮會穎 ,  葉寰 , 操敏

首都醫科大學附屬北京胸科醫院（北京 101125）;

Corresponding?author：

葉寰, Email: yedahuan@yeah.net

Keywords：

隱源性機化性肺炎; 臨床特征; 影像學表現; 病理學

DOI：

10.7507/1671-6205.202401018

Video：

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目的分析62例經病理確診的隱源性機化性肺炎患者，總結隱源性機化性肺炎的臨床表現、實驗室檢查、影像學、病理學等特點，加深臨床醫師對隱源性機化性肺炎的認識。方法收集2019年3月1日—2023年5月31日于首都醫科大學附屬北京胸科醫院住院，經病理診斷為隱源性機化性肺炎的患者的臨床資料，回顧性分析其臨床表現、實驗室檢查、影像學資料等。結果 62例患者中男53例，女9例，平均年齡（60.26±9.91）歲。癥狀以咳嗽、咳痰多見，部分患者伴有發熱、咯血、呼吸困難。胸部CT表現為肺部實變、斑片、結節影等，病變多位于胸膜下，可伴有支氣管充氣征、胸腔積液、胸膜增厚，以及縱隔、肺門淋巴結腫大等。肺功能可能表現為阻塞性通氣功能障礙、限制性通氣功能障礙及彌散異常等。結論隱源性機化性肺炎的臨床特征、實驗室檢查及影像學表現缺乏特異性，常需與肺部感染、惡性腫瘤進行鑒別，確診需病理學支持。

Citation： 馮會穎, 葉寰, 操敏. 隱源性機化性肺炎的臨床特點分析. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(5): 352-354. doi: 10.7507/1671-6205.202401018 Copy

1.	Davison AG, Heard BE, McAllister WA, et al. Cryptogenic organizing pneumonitis. Q J Med, 1983, 52(207): 382-394.
2.	Epler GR, Colby TV, McLoud TC, et al. Bronchiolitis obliterans organizing pneumonia. N Engl J Med, 1985, 312(3): 152-158.
3.	師紅軍. 隱源性機化性肺炎的發病機理及診療進展. 北京: 第二屆醫師進修峰會暨中醫藥產業發展論壇學術會議, 2018, 3-5.
4.	King TE Jr, Lee JS. Cryptogenic organizing pneumonia. N Engl J Med, 2022, 386(11): 1058-1069.
5.	趙琪, 孫婷婷, 陳露露, 等. 繼發性機化性肺炎3例臨床診治分析. 中華實用診斷與治療雜志, 2018, 32(12): 1222-1223.
6.	金如月, 劉秀明, 朱佳榮, 等. 9例感染后繼發性機化性肺炎患者的臨床分析. 重慶醫學, 2019, 48(2): 326-328.
7.	郭玲玲, 童波, 夏順生, 等. 感染后繼發性機化性肺炎1例報道并文獻復習. 臨床肺科雜志, 2014(6): 1158-1159.
8.	童歡. 基于隱源性機化性肺炎及繼發性機化性肺炎的臨床特征及影像特點研究. 健康必讀, 2021, 32(4): 73.
9.	Baha A, Y?ld?r?m F, K?ktürk N, et al. Cryptogenic and secondary organizing pneumonia: clinical presentation, radiological and laboratory findings, treatment, and prognosis in 56 Cases. Turk Thorac J, 2018, 19(4): 201-208.
10.	林遠生, 邱玉芳, 袁小亮. 隱源性機化性肺炎及繼發性機化性肺炎的臨床特征及影像特點分析. 贛南醫學院學報, 2019, 39(11): 1156-1159.
11.	Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M, et al. Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest, 2011, 139(4): 893-900.
12.	Y?lmaz S, Ak?nc? ?zyürek B, Erdo?an Y, et al. Retrospective evaluation of patients with organizing pneumonia: is cryptogenic organizing pneumonia different from secondary organizing pneumonia?. Tuberk Toraks, 2017, 65(1): 1-8.
13.	陳智鴻, 譚于飛, 張連鵬, 等. 纖維蛋白原和D-二聚體對隱源性機化性肺炎復發的預測價值. 中華結核和呼吸雜志, 2019, 42(4): 297-299.
14.	李惠萍, 范峰, 李秋紅, 等. 肺活檢證實隱源性機化性肺炎25例臨床診治體會. 中華結核和呼吸雜志, 2007, 30(4): 259-264.
15.	邱玉英, 苗立云, 蔡后榮, 等. 急性纖維素性機化性肺炎五例臨床和影像及病理分析. 中華結核和呼吸雜志, 2013, 36(6): 425-430.
16.	Zhang Y, Li N, Li Q, et al. Analysis of the clinical characteristics of 176 patients with pathologically confirmed cryptogenic organizing pneumonia. Ann Transl Med, 2020, 8(12): 763.
17.	Choi KJ, Yoo EH, Kim KC, et al. Comparison of clinical features and prognosis in patients with cryptogenic and secondary organizing pneumonia. BMC Pulm Med, 2021, 21(1): 336.
18.	Vasu TS, Cavallazzi R, Hirani A, et al. Clinical and radiologic distinctions between secondary bronchiolitis obliterans organizing pneumonia and cryptogenic organizing pneumonia. Respir Care, 2009, 54(8): 1028-1032.
19.	Saito Z, Kaneko Y, Hasegawa T, et al. Predictive factors for relapse of cryptogenic organizing pneumonia. BMC Pulm Med, 2019, 19(1): 10.
20.	Oikonomou A, Hansell DM. Organizing pneumonia: the many morphological faces. Eur Radiol, 2002, 12(6): 1486-96.
21.	Cho YH, Chae EJ, Song JW, et al. Chest CT imaging features for prediction of treatment response in cryptogenic and connective tissue disease-related organizing pneumonia. Eur Radiol, 2020, 30(5): 2722-2730.
22.	Pardo J, Panizo A, Sola I, et al. Prognostic value of clinical, morphologic, and immunohistochemical factors in patients with bronchiolitis obliterans-organizing pneumonia. Hum Pathol, 2013, 44(5): 718-724.

1. Davison AG, Heard BE, McAllister WA, et al. Cryptogenic organizing pneumonitis. Q J Med, 1983, 52(207): 382-394.
2. Epler GR, Colby TV, McLoud TC, et al. Bronchiolitis obliterans organizing pneumonia. N Engl J Med, 1985, 312(3): 152-158.
3. 師紅軍. 隱源性機化性肺炎的發病機理及診療進展. 北京: 第二屆醫師進修峰會暨中醫藥產業發展論壇學術會議, 2018, 3-5.
4. King TE Jr, Lee JS. Cryptogenic organizing pneumonia. N Engl J Med, 2022, 386(11): 1058-1069.
5. 趙琪, 孫婷婷, 陳露露, 等. 繼發性機化性肺炎3例臨床診治分析. 中華實用診斷與治療雜志, 2018, 32(12): 1222-1223.
6. 金如月, 劉秀明, 朱佳榮, 等. 9例感染后繼發性機化性肺炎患者的臨床分析. 重慶醫學, 2019, 48(2): 326-328.
7. 郭玲玲, 童波, 夏順生, 等. 感染后繼發性機化性肺炎1例報道并文獻復習. 臨床肺科雜志, 2014(6): 1158-1159.
8. 童歡. 基于隱源性機化性肺炎及繼發性機化性肺炎的臨床特征及影像特點研究. 健康必讀, 2021, 32(4): 73.
9. Baha A, Y?ld?r?m F, K?ktürk N, et al. Cryptogenic and secondary organizing pneumonia: clinical presentation, radiological and laboratory findings, treatment, and prognosis in 56 Cases. Turk Thorac J, 2018, 19(4): 201-208.
10. 林遠生, 邱玉芳, 袁小亮. 隱源性機化性肺炎及繼發性機化性肺炎的臨床特征及影像特點分析. 贛南醫學院學報, 2019, 39(11): 1156-1159.
11. Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M, et al. Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest, 2011, 139(4): 893-900.
12. Y?lmaz S, Ak?nc? ?zyürek B, Erdo?an Y, et al. Retrospective evaluation of patients with organizing pneumonia: is cryptogenic organizing pneumonia different from secondary organizing pneumonia?. Tuberk Toraks, 2017, 65(1): 1-8.
13. 陳智鴻, 譚于飛, 張連鵬, 等. 纖維蛋白原和D-二聚體對隱源性機化性肺炎復發的預測價值. 中華結核和呼吸雜志, 2019, 42(4): 297-299.
14. 李惠萍, 范峰, 李秋紅, 等. 肺活檢證實隱源性機化性肺炎25例臨床診治體會. 中華結核和呼吸雜志, 2007, 30(4): 259-264.
15. 邱玉英, 苗立云, 蔡后榮, 等. 急性纖維素性機化性肺炎五例臨床和影像及病理分析. 中華結核和呼吸雜志, 2013, 36(6): 425-430.
16. Zhang Y, Li N, Li Q, et al. Analysis of the clinical characteristics of 176 patients with pathologically confirmed cryptogenic organizing pneumonia. Ann Transl Med, 2020, 8(12): 763.
17. Choi KJ, Yoo EH, Kim KC, et al. Comparison of clinical features and prognosis in patients with cryptogenic and secondary organizing pneumonia. BMC Pulm Med, 2021, 21(1): 336.
18. Vasu TS, Cavallazzi R, Hirani A, et al. Clinical and radiologic distinctions between secondary bronchiolitis obliterans organizing pneumonia and cryptogenic organizing pneumonia. Respir Care, 2009, 54(8): 1028-1032.
19. Saito Z, Kaneko Y, Hasegawa T, et al. Predictive factors for relapse of cryptogenic organizing pneumonia. BMC Pulm Med, 2019, 19(1): 10.
20. Oikonomou A, Hansell DM. Organizing pneumonia: the many morphological faces. Eur Radiol, 2002, 12(6): 1486-96.
21. Cho YH, Chae EJ, Song JW, et al. Chest CT imaging features for prediction of treatment response in cryptogenic and connective tissue disease-related organizing pneumonia. Eur Radiol, 2020, 30(5): 2722-2730.
22. Pardo J, Panizo A, Sola I, et al. Prognostic value of clinical, morphologic, and immunohistochemical factors in patients with bronchiolitis obliterans-organizing pneumonia. Hum Pathol, 2013, 44(5): 718-724.

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隱源性機化性肺炎的臨床特點分析

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