中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2015年
9期
966-971
,共6页
潘明鸣%郭岩斐%方芳%孙铁英
潘明鳴%郭巖斐%方芳%孫鐵英
반명명%곽암비%방방%손철영
肺疾病,间质性%组织检查,针吸
肺疾病,間質性%組織檢查,針吸
폐질병,간질성%조직검사,침흡
Lung diseases,interstitial%Biopsy,needle
目的 分析急性纤维素性机化性肺炎(AFOP)患者的临床特征、诊断、治疗及转归.方法 报道1例病理诊断AFOP、经糖皮质激素(激素)治疗后好转的80岁患者,回顾分析国内外已报道的51例患者的临床资料,比较老年和非老年患者临床表现的差异. 结果 患者女性,既往患成人隐匿性自身免疫糖尿病,表现为发热、咳嗽、活动后气短,胸部CT示双肺多发实变影,CT引导下经皮肺穿刺活检确诊AFOP;口服激素治疗后病情好转,激素减量过程中复发,经治疗再次好转稳定.联合本例共纳入51例进行分析,男性27例,女性24例,年龄出生38 d至80岁,60岁及以上的老年人24例(47.1％).多数患者无明确诱发因素,合并免疫系统疾病最常见.常见症状的前三位为呼吸困难41例(80.4％)、咳嗽33例(64.7％)和发热27例(52.9％).老年患者出现呼吸困难少于非老年患者,66.7％(16/24)比92.6％(25/27),差异有统计学意义(P＜0.05),胸部影像出现磨玻璃影表现者也较少(P＜0.05).15例(29.4％)患者经皮肺穿刺或经支气管镜肺活检等微创手段确诊.治疗主要应用激素,39侧(76.5％)治疗中应用抗菌药物.AFOP的病死率为37.3％(15例);死亡患者从发病到确诊的时间平均19 d,好转患者40 d(P＜0.05);死亡患者应用有创机械通气57.9％(11/19),好转为9.4％(3/32),P＜0.05. 结论 AFOP的临床、影像表现缺乏特异性,易误诊为感染性疾病.老年人是AFOP的相对高发人群,呼吸困难等症状易被忽视,微创活检手段有助于确诊.AFOP病死率较高,激素治疗时间不足易导致疾病复发,疾病迅速进展和需应用有创机械通气提示预后不良.
目的 分析急性纖維素性機化性肺炎(AFOP)患者的臨床特徵、診斷、治療及轉歸.方法 報道1例病理診斷AFOP、經糖皮質激素(激素)治療後好轉的80歲患者,迴顧分析國內外已報道的51例患者的臨床資料,比較老年和非老年患者臨床錶現的差異. 結果 患者女性,既往患成人隱匿性自身免疫糖尿病,錶現為髮熱、咳嗽、活動後氣短,胸部CT示雙肺多髮實變影,CT引導下經皮肺穿刺活檢確診AFOP;口服激素治療後病情好轉,激素減量過程中複髮,經治療再次好轉穩定.聯閤本例共納入51例進行分析,男性27例,女性24例,年齡齣生38 d至80歲,60歲及以上的老年人24例(47.1％).多數患者無明確誘髮因素,閤併免疫繫統疾病最常見.常見癥狀的前三位為呼吸睏難41例(80.4％)、咳嗽33例(64.7％)和髮熱27例(52.9％).老年患者齣現呼吸睏難少于非老年患者,66.7％(16/24)比92.6％(25/27),差異有統計學意義(P＜0.05),胸部影像齣現磨玻璃影錶現者也較少(P＜0.05).15例(29.4％)患者經皮肺穿刺或經支氣管鏡肺活檢等微創手段確診.治療主要應用激素,39側(76.5％)治療中應用抗菌藥物.AFOP的病死率為37.3％(15例);死亡患者從髮病到確診的時間平均19 d,好轉患者40 d(P＜0.05);死亡患者應用有創機械通氣57.9％(11/19),好轉為9.4％(3/32),P＜0.05. 結論 AFOP的臨床、影像錶現缺乏特異性,易誤診為感染性疾病.老年人是AFOP的相對高髮人群,呼吸睏難等癥狀易被忽視,微創活檢手段有助于確診.AFOP病死率較高,激素治療時間不足易導緻疾病複髮,疾病迅速進展和需應用有創機械通氣提示預後不良.
목적 분석급성섬유소성궤화성폐염(AFOP)환자적림상특정、진단、치료급전귀.방법 보도1례병리진단AFOP、경당피질격소(격소)치료후호전적80세환자,회고분석국내외이보도적51례환자적림상자료,비교노년화비노년환자림상표현적차이. 결과 환자녀성,기왕환성인은닉성자신면역당뇨병,표현위발열、해수、활동후기단,흉부CT시쌍폐다발실변영,CT인도하경피폐천자활검학진AFOP;구복격소치료후병정호전,격소감량과정중복발,경치료재차호전은정.연합본례공납입51례진행분석,남성27례,녀성24례,년령출생38 d지80세,60세급이상적노년인24례(47.1％).다수환자무명학유발인소,합병면역계통질병최상견.상견증상적전삼위위호흡곤난41례(80.4％)、해수33례(64.7％)화발열27례(52.9％).노년환자출현호흡곤난소우비노년환자,66.7％(16/24)비92.6％(25/27),차이유통계학의의(P＜0.05),흉부영상출현마파리영표현자야교소(P＜0.05).15례(29.4％)환자경피폐천자혹경지기관경폐활검등미창수단학진.치료주요응용격소,39측(76.5％)치료중응용항균약물.AFOP적병사솔위37.3％(15례);사망환자종발병도학진적시간평균19 d,호전환자40 d(P＜0.05);사망환자응용유창궤계통기57.9％(11/19),호전위9.4％(3/32),P＜0.05. 결론 AFOP적림상、영상표현결핍특이성,역오진위감염성질병.노년인시AFOP적상대고발인군,호흡곤난등증상역피홀시,미창활검수단유조우학진.AFOP병사솔교고,격소치료시간불족역도치질병복발,질병신속진전화수응용유창궤계통기제시예후불량.
Objective To explore the characteristics of clinical features,diagnosis,treatment and prognosis in acute fibrinous and organizing pneumonia (AFOP) patients.Methods We described an 80-year-old woman who was diagnosed with AFOP and got better after treatment with glucocorticoids.Clinical data of 51 patients which have been published in literatures in China and abroad were retrospectively analyzed.The differences in characteristics of clinical features were compared between the elderly and non-elderly patients.Results The case reported herein,who was a 80-year-old female with latent autoimmune diabetes in adults (LADA),presented with fever,dry cough and progressive dyspnea.Chest CT scan showed bilateral multiple patchy consolidation.CT-guided needle aspiration was performed and the pathological examination finding was consistent with AFOP.The patient was treated with oral methylprednisolone and experienced a significant improvement in symptoms and imaging manifestations.But she presented with deterioration with relapsing clinical symptoms when she discontinued corticosteroid treatment by herself,and the clinical symptoms were improved by retreatment.Clinical data of 51 reported cases with AFOP including 27 males and 24 females aged 38 d to 80 years were enrolled and analyzed in the study.Patients aged 60 years and over accounted for 47.1％ (24 cases).No risk or predisposing factor was found in most of cases.Autoimmune diseases were the most common combined diseases in AFOP patients.The top three symptoms were dyspnea (80.4％,41 cases),cough (64.7％,33 cases) and fever (52.9％,27 cases).The incidence of dyspnea was lower in elderly patients than in non-elderly patients [66.7％ (16/24) vs.92.6％ (25/27),P＜0.05],and ground glass opacity in the chest image was also less in elderly patients than in non-elderly patients (P＜0.05).15 patients (29.4％) got definitive diagnosis by minimally invasive procedures including percutaneous lung puncture biopsy or transbronchial lung biopsy.Corticosteroids were the main drug treatment,and 39 cases (76.5 ％) received antibacterial drugs.The mortality rate of AFOP was 37.3％ (15 cases).The average time from symptom onset to final diagnosis was shorter in dead cases than in recovered patients (19 days vs.40 days,P＜0.05).The rate of using mechanical ventilation was higher in dead cases than in recovered patients [57.9 ％ (11/19) vs.9.4％ (3/32),P＜0.05].Conclusions There are no specific clinical and imaging features in AFOP,which is easily misdiagnosed as infectious diseases.AFOP is more common in elderly patients.Dyspnea and other symptoms can easily be ignored,and minimally invasive biopsy and pathological examination findings is helpful for diagnosis.The mortality rate of AFOP is high,and insufficient course of therapy is associated with the increased risk of AFOP relapse.Rapid progression of disease and the invasive mechanical ventilation predispose poor outcomes.
