隐源性机化性肺炎的临床特点分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

冯会颖 ,  叶寰 , 操敏

首都医科大学附属北京胸科医院（北京 101125）;

Corresponding author：

叶寰, Email: yedahuan@yeah.net

Keywords：

隐源性机化性肺炎; 临床特征; 影像学表现; 病理学

DOI：

10.7507/1671-6205.202401018

Video：

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目的分析62例经病理确诊的隐源性机化性肺炎患者，总结隐源性机化性肺炎的临床表现、实验室检查、影像学、病理学等特点，加深临床医师对隐源性机化性肺炎的认识。方法收集2019年3月1日—2023年5月31日于首都医科大学附属北京胸科医院住院，经病理诊断为隐源性机化性肺炎的患者的临床资料，回顾性分析其临床表现、实验室检查、影像学资料等。结果 62例患者中男53例，女9例，平均年龄（60.26±9.91）岁。症状以咳嗽、咳痰多见，部分患者伴有发热、咯血、呼吸困难。胸部CT表现为肺部实变、斑片、结节影等，病变多位于胸膜下，可伴有支气管充气征、胸腔积液、胸膜增厚，以及纵隔、肺门淋巴结肿大等。肺功能可能表现为阻塞性通气功能障碍、限制性通气功能障碍及弥散异常等。结论隐源性机化性肺炎的临床特征、实验室检查及影像学表现缺乏特异性，常需与肺部感染、恶性肿瘤进行鉴别，确诊需病理学支持。

Citation： 冯会颖, 叶寰, 操敏. 隐源性机化性肺炎的临床特点分析. 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.	师红军. 隐源性机化性肺炎的发病机理及诊疗进展. 北京: 第二届医师进修峰会暨中医药产业发展论坛学术会议, 2018, 3-5.
4.	King TE Jr, Lee JS. Cryptogenic organizing pneumonia. N Engl J Med, 2022, 386(11): 1058-1069.
5.	赵琪, 孙婷婷, 陈露露, 等. 继发性机化性肺炎3例临床诊治分析. 中华实用诊断与治疗杂志, 2018, 32(12): 1222-1223.
6.	金如月, 刘秀明, 朱佳荣, 等. 9例感染后继发性机化性肺炎患者的临床分析. 重庆医学, 2019, 48(2): 326-328.
7.	郭玲玲, 童波, 夏顺生, 等. 感染后继发性机化性肺炎1例报道并文献复习. 临床肺科杂志, 2014(6): 1158-1159.
8.	童欢. 基于隐源性机化性肺炎及继发性机化性肺炎的临床特征及影像特点研究. 健康必读, 2021, 32(4): 73.
9.	Baha A, Yıldırım F, Köktürk 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.	林远生, 邱玉芳, 袁小亮. 隐源性机化性肺炎及继发性机化性肺炎的临床特征及影像特点分析. 赣南医学院学报, 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.	Yılmaz S, Akıncı Özyürek B, Erdoğan 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.	陈智鸿, 谭于飞, 张连鹏, 等. 纤维蛋白原和D-二聚体对隐源性机化性肺炎复发的预测价值. 中华结核和呼吸杂志, 2019, 42(4): 297-299.
14.	李惠萍, 范峰, 李秋红, 等. 肺活检证实隐源性机化性肺炎25例临床诊治体会. 中华结核和呼吸杂志, 2007, 30(4): 259-264.
15.	邱玉英, 苗立云, 蔡后荣, 等. 急性纤维素性机化性肺炎五例临床和影像及病理分析. 中华结核和呼吸杂志, 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. 师红军. 隐源性机化性肺炎的发病机理及诊疗进展. 北京: 第二届医师进修峰会暨中医药产业发展论坛学术会议, 2018, 3-5.
4. King TE Jr, Lee JS. Cryptogenic organizing pneumonia. N Engl J Med, 2022, 386(11): 1058-1069.
5. 赵琪, 孙婷婷, 陈露露, 等. 继发性机化性肺炎3例临床诊治分析. 中华实用诊断与治疗杂志, 2018, 32(12): 1222-1223.
6. 金如月, 刘秀明, 朱佳荣, 等. 9例感染后继发性机化性肺炎患者的临床分析. 重庆医学, 2019, 48(2): 326-328.
7. 郭玲玲, 童波, 夏顺生, 等. 感染后继发性机化性肺炎1例报道并文献复习. 临床肺科杂志, 2014(6): 1158-1159.
8. 童欢. 基于隐源性机化性肺炎及继发性机化性肺炎的临床特征及影像特点研究. 健康必读, 2021, 32(4): 73.
9. Baha A, Yıldırım F, Köktürk 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. 林远生, 邱玉芳, 袁小亮. 隐源性机化性肺炎及继发性机化性肺炎的临床特征及影像特点分析. 赣南医学院学报, 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. Yılmaz S, Akıncı Özyürek B, Erdoğan 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. 陈智鸿, 谭于飞, 张连鹏, 等. 纤维蛋白原和D-二聚体对隐源性机化性肺炎复发的预测价值. 中华结核和呼吸杂志, 2019, 42(4): 297-299.
14. 李惠萍, 范峰, 李秋红, 等. 肺活检证实隐源性机化性肺炎25例临床诊治体会. 中华结核和呼吸杂志, 2007, 30(4): 259-264.
15. 邱玉英, 苗立云, 蔡后荣, 等. 急性纤维素性机化性肺炎五例临床和影像及病理分析. 中华结核和呼吸杂志, 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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