CAJ | 학술논문

目的探讨重症急进型隐源性机化性肺炎(COP)的临床特征.方法总结2003年10月至2014年3月南京医科大学第一附属医院经肺活检证实的9例合并急性呼吸衰竭的重症急进型COP患者的临床资料并进行分析.结果 9例患者中男5例,女4例;年龄42～71岁,平均(52.1±11.4)岁.病程7～20 d,平均(11.2±3.7)d.主要症状:咳嗽9例,呼吸困难9例,发热7例,乏力6例,体重下降3例,盗汗2例,咯血1例.主要体征:发绀9例,肺部爆裂音6例,湿哕音3例.实验室检查结果异常包括:外周血白细胞增高6例,中性粒细胞百分比增高8例,红细胞沉降率增快8例,C-反应蛋白升高8例,血清铁蛋白增高6例,所有患者动脉血气分析PaO2 ＜60 mmHg(1 mmHg=0.133 kPa).胸部高分辨率CT示:均为双侧分布,多发病变;呈大片肺实变影5例,呈弥漫性毛玻璃影4例.合并支气管充气症5例,伴双侧胸腔积液2例,牵拉性支气管扩张2例,自发性气胸1例.经常规剂量糖皮质激素治疗,6例缓解,3例效果不明显改糖皮质激素冲击治疗缓解,2例复发者再次治疗后治愈.结论重症急进型COP患者全身炎症反应重,早期进展为呼吸衰竭.肺部病变广泛,可合并胸腔积液和自发性气胸等少见表现.常规剂量糖皮质激素治疗有效,部分患者需糖皮质激素冲击治疗.
목적 탐토중증급진형은원성궤화성폐염(COP)적림상특정.방법 총결2003년10월지2014년3월남경의과대학제일부속의원경폐활검증실적9례합병급성호흡쇠갈적중증급진형COP환자적림상자료병진행분석.결과 9례환자중남5례,녀4례;년령42～71세,평균(52.1±11.4)세.병정7～20 d,평균(11.2±3.7)d.주요증상:해수9례,호흡곤난9례,발열7례,핍력6례,체중하강3례,도한2례,각혈1례.주요체정:발감9례,폐부폭렬음6례,습홰음3례.실험실검사결과이상포괄:외주혈백세포증고6례,중성립세포백분비증고8례,홍세포침강솔증쾌8례,C-반응단백승고8례,혈청철단백증고6례,소유환자동맥혈기분석PaO2 ＜60 mmHg(1 mmHg=0.133 kPa).흉부고분변솔CT시:균위쌍측분포,다발병변;정대편폐실변영5례,정미만성모파리영4례.합병지기관충기증5례,반쌍측흉강적액2례,견랍성지기관확장2례,자발성기흉1례.경상규제량당피질격소치료,6례완해,3례효과불명현개당피질격소충격치료완해,2례복발자재차치료후치유.결론 중증급진형COP환자전신염증반응중,조기진전위호흡쇠갈.폐부병변엄범,가합병흉강적액화자발성기흉등소견표현.상규제량당피질격소치료유효,부분환자수당피질격소충격치료.
Obiective To explore the clinical features of rapidly progressive crytogenic organizing pneumonia (COP).Methods Nine cases of rapidly progressive COP with acute respiratory failure confirmed by lung biopsy at First Affiliated Hospital,Nanjing Medical University from October 2003 to March 2014 were retrospectively reviewed.Results There were 5 males and 4 females with an age range of (52.1 ± 11.4) years.The onset of illness was 7-20 days.The major manifestations included cough (n =9),dyspnea (n =9),fever (n =7),hypodynamia (n =6),weight loss (n =3),night sweat (n =2),hemoptysis (n =1),cyanosis (n =9),"velcro" crackles (n =6) and moist rales (n =3).Blood tests showed elevated levels of erythrocyte sedimentation rate (n =8),C-reactive protein (n =8) and serum ferritin (n =6).The results of blood gas analysis indicated acute respiratory failure in all 9 patients (PaO2 ＜60 mmHg,1 mmHg =0.133 kPa).Chest computed tomography showed bilateral and multiple distribution,patchy areas of alveolar consolidation with air bronchograms (n =5),diffuse ground-glass opacity (n =4),tractional bronchiectasis (n =2),pleural effusion (n =2) and spontaneous pneumothorax (n =1).Six cases were cured by conventional dose corticosteroid and another 3 by large-dose methylprednisolone (240 mg/d).Two cases relapsed and then recovered after a second corticosteroid therapy.Conclusions The clinical manifestations of rapidly progressive COP show severe inflammatory reactions with a fast progression.Chest computed tomography depicts extensive lesions along with pleural effusion and spontaneous pneumothorax.Conventional dose of corticosteroid is the first choice therapy for rapidly progressive COP.Large-dose methylprednisolone is needed when conventional dose of corticosteroid proves ineffective.