纤维支气管镜在隐源性机化性肺炎诊治中的价值

The value of fiberoptic bronchoscopy in cryptogenic organizing pneumonia diagnosis and therapy

摘要:

目的 探讨纤维支气管镜在隐源性机化性肺炎（COP）诊断及治疗过程中的价值。方法 回顾性分析2008年～2012年该院住院，经纤维支气管肺组织活检（TBLB）取得病理依据，根据最终确诊为隐源性机化性肺炎6例患者的临床资料，总结COP的临床特征及纤维支气管镜应用经验。结果 6例隐源性机化性肺炎患者平均年龄为（52.5±12）岁，平均发病时间为2.5个月，临床表现为咳嗽、咳痰、劳力性气促及发热等，4例可闻及湿啰音，无杵状指。5例患者白细胞正常，1例增高，5例血沉以及C反应蛋白增高，2例有低氧血症，4例为限制性通气功能障碍，5例有弥散功能障碍。影像学主要表现为双下肺斑片状高密度影，伴有条索状影、支气管充气征和空洞等，未见蜂窝样影。肺组织病理病变形态呈阻塞性细支气管炎并机化性肺炎改变，所有患者仅需单次TBLB确诊，过程简单无并发症。6例患者均口服糖皮质激素治疗而痊愈，随访2年无复发。结论 COP常误诊肺部炎症，但抗感染无效，肺部影像学表现为多样性的实质、间质改变，确诊需要病理依据，TBLB操作简单、并发症少、阳性率高、可重复性及可作为首选有创检查。糖皮质激素治疗效果佳，预后好。

Abstract:

【Objective】 To explore the value of fiberoptic bronchoscopy in cryptogenic organizing pneumonia diagnosis and treatment process. 【Methods】 6 patients clinical data finally diagnosed as cryptogenic organizing pneumonia by pathological basis via fiberoptic bronchial lung biopsy (TBLB) from 2008~2012 in our hospital were retrospectively analyzed. 【Results】 The average age of 6 cryptogenic organizing pneumonia patients was (52.5±12) years of age, the average time of onset was 2.5 months, clinical manifestations of cough, expectoration, exertional shortness of breath, fever, crackles on auscultation in 4 cases, no clubbing. WBC normal in 5 patients, increased in 1 case, the erythrocyte sedimentation rate, C-reactive protein increased in 5 cases, two cases of hypoxemia, 4 cases of restrictive ventilatory dysfunction, 5 patients with diffuse dysfunction. Imaging performance for the lesions bilaterally patching, consolidation, air bronchogram, mass. Pathological findings prompt submission lung tissue lesion morphology was bronchiolitis obliterans organizing pneumonia. All patients only once TBLB diagnosed, the process was simple and without complications. 6 patients were oral glucocorticoid treatment and recovery, follow-up of 2 years without concurrence. 【Conclusion】 COP is often misdiagnosed as lung inflammation, but anti-infective invalid. Lung imaging showed the diversity of the substance and interstitial changes. Diagnosis requires pathological basis, TBLB operation is simple, with fewer complications, positive rate, repeatability. Glucocorticoid is the most effective drug for COP, the prognosis is good.