Li Hui-Ping, Fan Feng, Li Qiu-Hong, Zhao Lan, Li Xia, Yu Hui, Zhang Rong-Xuan, Yi Xiang-Hua, Shi Jing-Yun, He Guo-Jun
Department of Respiratory Diseases, Shanghai Pulmonary Hospital, Shanghai 200433, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2007 Apr;30(4):259-64.
To analyze the clinical, radiological and pathological features, diagnosis and response to therapy as well as prognosis of 25 cases of cryptogenic organizing pneumonia (COP).
Twenty-five subjects with COP confirmed by lung biopsy in Shanghai Pulmonary Hospital from January of 2000 to April of 2006 were retrospectively reviewed. Secondary reaction to infections, drugs, radiation, connective tissue diseases and various noxious agents were excluded. Their clinical-pathological characteristics, radiological features, response to treatment, relapse, survival were obtained from medical records and a follow-up patient questionnaire.
There were 6 males and 19 females, with a mean age of 56 years (range 40 - 73 years). The presentations included cough (25/25), clear sputum (21/25), dyspnea (17/25), hemoptysis (5/25), fever and sweats (3/25), and "Velcro" crackles (18/25). Four of them were smokers, 11 had allergic reaction to some drugs, and 11 had some industrious dust inhalation. In 23 cases the specimens were obtained by video-assisted thoracoscopy and 2 cases by transbronchial lung biopsy. Bilateral lung involvement was present in 23 cases and all of them had at least two different radiological manifestations. Twenty-four cases showed a sub-pleural distribution. Bilateral patchy alveolar and ground glass involvement were found in 8 cases, airspace consolidation in 8 cases, mass in 11 cases, irregular lines in 10 cases, small nodules (<10 mm) in 4 cases. Two patients received operation. Corticosteroid therapy was administered to 23 patients. Seventeen cases were cured, but 8 of them relapsed after stopping (n = 2) and tapering (n = 6, when prednisone less than 5 - 10 mg/d) of corticosteroids within one to two years of therapy.
COP is not very rare in China. The clinical-radiological-pathological diagnosis (CRP) is the most important diagnostic method. Corticosteroid is the first choice for COP therapy. The prognosis of COP is good if therapy is started in time, but relapse is common.
分析25例隐源性机化性肺炎（COP）的临床、影像学及病理特征、诊断、治疗反应及预后。
回顾性分析2000年1月至2006年4月在上海肺科医院经肺活检确诊为COP的25例患者。排除感染、药物、辐射、结缔组织病及各种有害因素引起的继发性反应。从病历及随访患者问卷中获取其临床病理特征、影像学特征、治疗反应、复发及生存情况。
男性6例，女性19例，平均年龄56岁（范围40 - 73岁）。临床表现包括咳嗽（25/25）、咳痰清稀（21/25）、呼吸困难（17/25）、咯血（5/25）、发热盗汗（3/25）及“Velcro”啰音（18/25）。其中4例吸烟，11例对某些药物有过敏反应，11例有职业性粉尘吸入史。23例通过电视辅助胸腔镜获取标本，2例通过经支气管肺活检获取标本。23例双侧肺受累，且均至少有两种不同的影像学表现。24例呈胸膜下分布。8例表现为双侧斑片状肺泡及磨玻璃影，8例为实变影，11例为肿块影，10例为不规则条索影，4例为小结节（<10 mm）。2例患者接受了手术。23例患者接受了糖皮质激素治疗。17例治愈，但其中8例在治疗后1至2年内停用（2例）及逐渐减量（6例，泼尼松小于5 - 10 mg/d时）糖皮质激素后复发。
COP在中国并非十分罕见。临床-影像学-病理诊断（CRP）是最重要的诊断方法。糖皮质激素是COP治疗的首选药物。COP若及时治疗预后良好，但复发常见。
