摘要
目的探讨急性爆发型隐源性机化性肺炎（AFCOP）的特点，以提高临床医师对其认识和诊治水平。方法回顾3例AFCOP的发病特点、临床表现、影像表现、实验室检查结果和诊治过程，结合相关资料总结其特点和诊治方法。结果①AFCOP常见于55岁左右，多无基础疾病。②诱因：可能为上呼吸道或消化道病毒感染。③症状：主要包括发热、全身酸痛、乏力、咳嗽、无痰或咳少量白黏痰，随病情进展而迅速出现气急或呼吸困难。④体征：主要为单侧或双侧的肺实变体征，肺部听诊可闻及湿哕音或爆裂音。⑤影像学表现：两肺多叶、段分布的沿支气管走行的实变影或渗出性病变，病程较长者或恢复期可见纤维条索样改变。⑥实验室检查：ESR和CRP明显升高、随病情的变化而变化，出现低氧血症和低碳酸血症，ANA多阳性，外周血WBC多在正常范围内、中性粒细胞比率增高，多伴肝功能和心肌酶谱的明显异常，尿常规多有异常。支气管肺泡灌洗液细胞学检查主要为单核细胞、淋巴细胞及嗜酸性粒细胞，而中性粒细胞比率较低。⑦诊断：有赖于病理组织学检查。⑧治疗：肾上腺糖皮质激素疗效显著。结论AFCOP的特点是诊断的线索，病理组织学检查是确诊的依据，早期诊断及治疗是良好预后的保证。
Objective To investigate the characteristics of acute fulminant cryptogenic organizing pneumonia （AFCOP）, and improve the clinical level of the diagnosis and treatment of AFCOP. Methods We retrospectively investigated the features, symptoms, imaging, laboratory test results, diagnosis and treatment of three patients with AFCOP, and combined with relevant information to summarize the characteristics and treatment of the disease. Results （1）The average age was about 55 - year- old, and most patients had no underlying diseases. （2）Incentives might be upper respiratory tract infection or gastrointestinal viral infection. （3）Symptoms were about fever, body aches, fatigue, cough, without sputum or producing a small amount of white phlegm, shortness of breath or difficulty breathing with the progress of the disease. （4）Physical examinations included signs of unilateral or bilateral lung consolidation, and wet rales or crackles on lung auscuhation. （5）Imaging findings were opacities or exudative lesions along bronchial tubes in multiple leaf or segments of both lungs, and fibrous cord - like changes in the patients with longer duration or convalescence, （6）Laboratory tests： ESR and CRP were significantly higher, and changed with the course of the disease. Hypoxemia and hypocapnia. ANA was commonly positive. Peripheral WBC count was commonly in normal range, and the neutrophil ratio increased. Many patients were always associated with obvious abnormalities in liver function and myocardial enzymes. Many had abnormal routine urinalysis. The cytology of bronchoalveolar lavage fluid was major monocytes, lymphocytes and eosinophils, but had a low proportion of neutrophils. （7）Diagnosis depended on histopathology. （8） Treatment： Glucocorticoid had a significant effect. Conclusion Thecharacteristics of AFCOP are the clues of diagnosis, and histopathology is the basis for confirmed diagnosis. Moreover, early diagnosis and treatment are guarantees for a good prognosis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2014年第5期410-415,482,共7页
Chinese Journal of Critical Care Medicine
