CAJ | 학술논문

目的观察急性纤维素性机化性肺炎的临床、影像学及病理特点,以提高临床医生对该病的认识.方法回顾性分析南京市鼓楼医院2011年3月至2012年6月通过CT引导下经皮肺穿刺活检确诊的5例急性纤维素性机化性肺炎患者的临床资料,总结其临床、影像学及病理特征.结果 5例患者中男2例,女3例,年龄43～61岁,均表现为亚急性起病,主要的临床症状为呼吸困难、咳嗽、咳痰、发热、胸痛,血气分析为低氧血症.胸部高分辨率CT主要表现为双肺弥漫性、斑片状分布的浸润影.主要病理表现为肺泡间隔略增宽,可见淋巴细胞和浆细胞浸润,肺泡腔内可见纤维母细胞呈息肉状延伸(机化)伴纤维素样红染物质,未见中性粒细胞和嗜酸粒细胞浸润,病理上不同于其他已确定的急性肺损伤,如弥漫性肺泡损伤、隐源性机化性肺炎及嗜酸粒细胞性肺炎.所有病例经糖皮质激素治疗后症状很快缓解,胸部影像学改变明显好转.结论急性纤维素性机化性肺炎临床表现缺乏特异性,诊断主要依赖组织病理学检查,对糖皮质激素治疗反应良好.但其是否为一种独立的间质性疾病有待进一步临床验证.
목적 관찰급성섬유소성궤화성폐염적림상、영상학급병리특점,이제고림상의생대해병적인식.방법 회고성분석남경시고루의원2011년3월지2012년6월통과CT인도하경피폐천자활검학진적5례급성섬유소성궤화성폐염환자적림상자료,총결기림상、영상학급병리특정.결과 5례환자중남2례,녀3례,년령43～61세,균표현위아급성기병,주요적림상증상위호흡곤난、해수、해담、발열、흉통,혈기분석위저양혈증.흉부고분변솔CT주요표현위쌍폐미만성、반편상분포적침윤영.주요병리표현위폐포간격략증관,가견림파세포화장세포침윤,폐포강내가견섬유모세포정식육상연신(궤화)반섬유소양홍염물질,미견중성립세포화기산립세포침윤,병리상불동우기타이학정적급성폐손상,여미만성폐포손상、은원성궤화성폐염급기산립세포성폐염.소유병례경당피질격소치료후증상흔쾌완해,흉부영상학개변명현호전.결론 급성섬유소성궤화성폐염림상표현결핍특이성,진단주요의뢰조직병이학검사,대당피질격소치료반응량호.단기시부위일충독립적간질성질병유대진일보림상험증.
Objective To improve understanding of the clinical,radiological and pathological characteristics of acute fibrinous and organizing pneumonia (AFOP).Methods The clinical data of 5 AFOP patients were retrospectively analyzed.AFOP was diagnosed via percutaneous lung biopsy guided by chest computerized tomography (CT) in the Affiliated Drum Tower Hospital of Nanjing University Medical School during March 2011 to June 2012.The clinical,radiological and pathological characteristics of those patients were summarized.Results Among the 5 patients,2 were male and 3 were female,aging 43-61 years.They were all subacute onset.The main clinical manifestations were dyspnea,productive cough,fever and chest pain with hypoxemia via blood gas analysis.Bilateral infiltrates with diffuse and pathy distribution were the predominant features in chest HRCT.The pathological examination revealed slightly widened alveolar septa,lymphocyte and plasma cell infiltration and the presence of intra-alveolar fibrin in the form of fibrin "balls" (organization) within the alveolar spaces.No neutrophil,and eosinophil infiltration and hyaline membrane formation were detected,which was different from other well-recognized histologic patterns of acute lung injury,such as diffuse alveolar damage,cryptogenic organizing pneumonia and eosinophilic pneumonia.All patients were treated by corticosteroids and showed significant clinical and radiological improvement.Conclusions AFOP has nospecific features,and its diagnosis depends on pathological examination.Treatment with corticosteroids is optimal.However,whether it is a unique interstitial disease needs to be further clinically investigated.