中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
14期
1595-1599
,共5页
张梅%赵云峰%骆益民%王忠江%刘磷琛%杨远%王西华%林勇
張梅%趙雲峰%駱益民%王忠江%劉燐琛%楊遠%王西華%林勇
장매%조운봉%락익민%왕충강%류린침%양원%왕서화%림용
隐原性%结缔组织疾病%机化性肺炎%体征和症状%预后
隱原性%結締組織疾病%機化性肺炎%體徵和癥狀%預後
은원성%결체조직질병%궤화성폐염%체정화증상%예후
Cryptogenic%Connective tissue disease%Organizing pneumonia%Signs and Symptoms%Prognosis
目的:对比分析隐原性与继发于结缔组织病的机化性肺炎( OP)的临床特征及预后。方法采用回顾性研究,选取东南大学附属中大医院2006年2月-2012年1月期间37例经病理证实的OP住院患者,根据临床症状、肺功能检查、免疫学检查和胸部高分辨率CT( HRCT)扫描等结果,结合典型的OP组织病理表现,经有经验的呼吸科、风湿科、放射科及病理科医生会诊后,剔除5例病因为药物、放射性治疗或感染所致的OP患者,最终纳入32例作为研究对象,并将其分为隐原性机化性肺炎( COP)组(14例)及继发于结缔组织病机化性肺炎( CTD-OP)组(18例)。两组患者给予糖皮质激素治疗3~12个月,随访18个月。比较两组患者的临床症状、肺功能指标、动脉血气分析指标、影像学特征及预后情况。结果两组患者的年龄、呼吸困难发生率、氧合指数( PaO2/FiO2)及C反应蛋白(CRP)比较,差异均无统计学意义(P﹥0.05);CTD-OP组的女性比例、类风湿因子(RF)阳性率、抗核抗体(ANA)阳性率均高于COP组(P﹤0.05)。两组间第1秒用力呼气容积占预计值百分比(FEV1%)、用力肺活量占预计值百分比( FVC%)、肺总量占预计值百分比( TLC%)、残气量占预计值百分比( RV%)、第1秒用力呼气容积/用力肺活量( FEV1/FVC)、一氧化碳弥散量占预计值百分比( DLCO%)、动脉血氧分压( PaO2)、二氧化碳分压( PaCO2)、肺泡-肺动脉氧分压差〔P( A-a) O2〕分别在治疗前和治疗后比较,差异均无统计学意义( P﹥0.05)。组内比较显示,治疗前两组患者的FEV1%、FVC%、TLC%、RV%、FEV1/FVC、DLCO%、PaO2、P( A-a) O2与治疗后比较,差异均有统计学意义( P﹤0.05)。两组的治疗方案比较,差异无统计学意义( P﹥0.05)。两组患者经激素治疗后总有效率为93.8%(30/32);两组的预后情况比较,差异有统计学意义(u=-2.080,P=0.038);COP组的痊愈率(50.0%)高于CTD-OP组(16.7%),复发率(7.1%)低于CTD-OP组(38.9%),差异有统计学意义(χ2=4.17、4.20,P=0.04、0.03)。结论 COP与CTD-OP患者早期临床症状相似,表现为轻、中度限制性通气功能障碍及弥散功能异常,轻度低氧血症;激素治疗早期阶段有效率高,在后期的随访中发现CTD-OP患者较COP患者复发率高、痊愈率低,故对OP患者需要定期随访。
目的:對比分析隱原性與繼髮于結締組織病的機化性肺炎( OP)的臨床特徵及預後。方法採用迴顧性研究,選取東南大學附屬中大醫院2006年2月-2012年1月期間37例經病理證實的OP住院患者,根據臨床癥狀、肺功能檢查、免疫學檢查和胸部高分辨率CT( HRCT)掃描等結果,結閤典型的OP組織病理錶現,經有經驗的呼吸科、風濕科、放射科及病理科醫生會診後,剔除5例病因為藥物、放射性治療或感染所緻的OP患者,最終納入32例作為研究對象,併將其分為隱原性機化性肺炎( COP)組(14例)及繼髮于結締組織病機化性肺炎( CTD-OP)組(18例)。兩組患者給予糖皮質激素治療3~12箇月,隨訪18箇月。比較兩組患者的臨床癥狀、肺功能指標、動脈血氣分析指標、影像學特徵及預後情況。結果兩組患者的年齡、呼吸睏難髮生率、氧閤指數( PaO2/FiO2)及C反應蛋白(CRP)比較,差異均無統計學意義(P﹥0.05);CTD-OP組的女性比例、類風濕因子(RF)暘性率、抗覈抗體(ANA)暘性率均高于COP組(P﹤0.05)。兩組間第1秒用力呼氣容積佔預計值百分比(FEV1%)、用力肺活量佔預計值百分比( FVC%)、肺總量佔預計值百分比( TLC%)、殘氣量佔預計值百分比( RV%)、第1秒用力呼氣容積/用力肺活量( FEV1/FVC)、一氧化碳瀰散量佔預計值百分比( DLCO%)、動脈血氧分壓( PaO2)、二氧化碳分壓( PaCO2)、肺泡-肺動脈氧分壓差〔P( A-a) O2〕分彆在治療前和治療後比較,差異均無統計學意義( P﹥0.05)。組內比較顯示,治療前兩組患者的FEV1%、FVC%、TLC%、RV%、FEV1/FVC、DLCO%、PaO2、P( A-a) O2與治療後比較,差異均有統計學意義( P﹤0.05)。兩組的治療方案比較,差異無統計學意義( P﹥0.05)。兩組患者經激素治療後總有效率為93.8%(30/32);兩組的預後情況比較,差異有統計學意義(u=-2.080,P=0.038);COP組的痊愈率(50.0%)高于CTD-OP組(16.7%),複髮率(7.1%)低于CTD-OP組(38.9%),差異有統計學意義(χ2=4.17、4.20,P=0.04、0.03)。結論 COP與CTD-OP患者早期臨床癥狀相似,錶現為輕、中度限製性通氣功能障礙及瀰散功能異常,輕度低氧血癥;激素治療早期階段有效率高,在後期的隨訪中髮現CTD-OP患者較COP患者複髮率高、痊愈率低,故對OP患者需要定期隨訪。
목적:대비분석은원성여계발우결체조직병적궤화성폐염( OP)적림상특정급예후。방법채용회고성연구,선취동남대학부속중대의원2006년2월-2012년1월기간37례경병리증실적OP주원환자,근거림상증상、폐공능검사、면역학검사화흉부고분변솔CT( HRCT)소묘등결과,결합전형적OP조직병리표현,경유경험적호흡과、풍습과、방사과급병이과의생회진후,척제5례병인위약물、방사성치료혹감염소치적OP환자,최종납입32례작위연구대상,병장기분위은원성궤화성폐염( COP)조(14례)급계발우결체조직병궤화성폐염( CTD-OP)조(18례)。량조환자급여당피질격소치료3~12개월,수방18개월。비교량조환자적림상증상、폐공능지표、동맥혈기분석지표、영상학특정급예후정황。결과량조환자적년령、호흡곤난발생솔、양합지수( PaO2/FiO2)급C반응단백(CRP)비교,차이균무통계학의의(P﹥0.05);CTD-OP조적녀성비례、류풍습인자(RF)양성솔、항핵항체(ANA)양성솔균고우COP조(P﹤0.05)。량조간제1초용력호기용적점예계치백분비(FEV1%)、용력폐활량점예계치백분비( FVC%)、폐총량점예계치백분비( TLC%)、잔기량점예계치백분비( RV%)、제1초용력호기용적/용력폐활량( FEV1/FVC)、일양화탄미산량점예계치백분비( DLCO%)、동맥혈양분압( PaO2)、이양화탄분압( PaCO2)、폐포-폐동맥양분압차〔P( A-a) O2〕분별재치료전화치료후비교,차이균무통계학의의( P﹥0.05)。조내비교현시,치료전량조환자적FEV1%、FVC%、TLC%、RV%、FEV1/FVC、DLCO%、PaO2、P( A-a) O2여치료후비교,차이균유통계학의의( P﹤0.05)。량조적치료방안비교,차이무통계학의의( P﹥0.05)。량조환자경격소치료후총유효솔위93.8%(30/32);량조적예후정황비교,차이유통계학의의(u=-2.080,P=0.038);COP조적전유솔(50.0%)고우CTD-OP조(16.7%),복발솔(7.1%)저우CTD-OP조(38.9%),차이유통계학의의(χ2=4.17、4.20,P=0.04、0.03)。결론 COP여CTD-OP환자조기림상증상상사,표현위경、중도한제성통기공능장애급미산공능이상,경도저양혈증;격소치료조기계단유효솔고,재후기적수방중발현CTD-OP환자교COP환자복발솔고、전유솔저,고대OP환자수요정기수방。
Objective To compare the clinical features and prognosis between cryptogenic organizing pneumonia ( COP)and connective tissue disease related organizing pneumonia(CTD - OP). Methods 37 in - patients diagnosed with OP by lung biopsy in Zhongda Hospital Affiliated of Southeast University from February 2006 to January 2012 were retrospectively studied. Five patients caused by medication,radioactive therapy and infection were removed from the study according to clinical features,lung function examination,immunologic test and HRCT as well as confirmation by experienced doctors. 32 patients were finally involved into the study and were randomly divided into COP group(14 cases)and CTD - OP group(18 cases). The two groups were treated by glucocorticoid for 3 to 12 months and were followed up for 18 months. The clinical features,lung function index,analysis index of arterial blood gases,imaging characteristics and prognosis were compared between the two groups. Results The age,dyspnea,PaO2 / FiO2 and CRP between the two groups showed no statistically significant difference (P ﹥0. 05). The incidence of women,the positive rate of serum RF and ANA in CTD - OP group were higher than in COP group(P ﹤0. 05). FEV1 %,FVC%,TLC%,RV%,FEV1 / FVC,DLCO%,PaO2 ,PaCO2 and P(A - a)O2 between the two groups showed no statistically significant difference before and after treatment(P ﹥0. 05). Comparison within groups showed that the FEV1 %,FVC%,TLC%,RV%,FEV1 / FVC,DLCO%,PaO2 and P(A - a)O2 before treatment both showed statistically significant differences( P ﹤ 0. 05). The treatment schemes between the two groups showed no statistically significant difference(P ﹥0. 05). The overall effective rate of the two groups after treated by glucocorticoid was 93. 8% (30/32),and the prognosis between the two groups showed statistically significant difference(u = -2. 080,P =0. 038). The cure rate of the COP group(50. 0%)was higher than the CTD - OP group(16. 7%),and the recurrence rate of the COP group(7. 1%)was lower than the CTD - OP group(38. 9%),both showing statistically significant differences( χ 2 = 4. 17,4. 20;P = 0. 04, 0. 03). Conclusion Patients with COP and CTD - OP have similar early stage clinical symptoms,which are mild and moderate restrictive ventilation abnormalities,diffuse dysfunction and mild hyoxemia. Early hormone treatment can achieve high efficacy in early stage,and following up shows that CTD - OP patients have higher recurrence rate and low cure rate than COP patients. Thus regular following up is necessary.