Third Pulmonary Medicine Department, Sismanoglion General Hospital, Maroussi, Greece.
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Brown University, Providence, RI.
Chest. 2011 Apr;139(4):893-900. doi: 10.1378/chest.10-0883. Epub 2010 Aug 19.
Organizing pneumonia (OP) is a distinct clinical and pathologic entity. This condition can be cryptogenic (COP) or secondary to other known causes (secondary OP). In the present study, we reviewed the features associated with COP and secondary OP in patients from two teaching hospitals.
The medical records of 61 patients with biopsy-proven OP were retrospectively reviewed. Forty patients were diagnosed with COP and 21 patients with secondary OP. The clinical presentation, radiographic studies, pulmonary function tests (PFTs), laboratory data, BAL findings, treatment, and outcome were analyzed.
The mean age at presentation was 60.46 ± 13.57 years. Malaise, cough, fever, dyspnea, bilateral alveolar infiltrates, and a restrictive pattern were the most common symptoms and findings. BAL lymphocytosis was observed in 43.8% of patients with OP. The relapse rate and mortality rate after 1 year of follow-up were 37.8% and 9.4%, respectively. The in-hospital mortality was 5.7%. The clinical presentation and radiographic findings did not differ significantly between patients with COP and secondary OP. A mixed PFT pattern (obstructive and restrictive physiology) and lower blood levels of serum sodium, serum potassium, platelets, albumin, protein, and pH were observed among patients with secondary OP. Higher blood levels of creatinine, bilirubin, Paco₂, and BAL lymphocytes were also more common among patients with secondary OP. There were no differences in the relapse rate or mortality between patients with COP and secondary OP. The 1-year mortality correlated with an elevated erythrocyte sedimentation rate, low albumin, and low hemoglobin levels.
The clinical and radiographic findings in patients with COP and secondary OP are similar and nonspecific. Although certain laboratory abnormalities are more common in secondary OP and can be associated with worse prognosis, they are likely due to the underlying disease. COP and secondary OP have similar treatment response, relapse rates, and mortality.
机化性肺炎（OP）是一种独特的临床和病理实体。这种情况可能是特发性的（COP），也可能继发于其他已知原因（继发性 OP）。在本研究中，我们回顾了两家教学医院的 COP 和继发性 OP 患者的相关特征。
回顾性分析了 61 例经活检证实的 OP 患者的病历。40 例患者被诊断为 COP，21 例患者为继发性 OP。分析了临床表现、影像学研究、肺功能检查（PFT）、实验室数据、BAL 结果、治疗和预后。
发病时的平均年龄为 60.46±13.57 岁。最常见的症状和表现为不适、咳嗽、发热、呼吸困难、双侧肺泡浸润和限制性模式。43.8%的 OP 患者 BAL 淋巴细胞增多。1 年后的复发率和死亡率分别为 37.8%和 9.4%。住院死亡率为 5.7%。COP 和继发性 OP 患者的临床表现和影像学表现无显著差异。继发性 OP 患者存在混合性 PFT 模式（阻塞性和限制性生理学）和较低的血清钠、血清钾、血小板、白蛋白、蛋白和 pH 值。继发性 OP 患者还更常见较高的血肌酐、胆红素、Paco₂和 BAL 淋巴细胞水平。COP 和继发性 OP 患者的复发率或死亡率无差异。1 年死亡率与红细胞沉降率升高、白蛋白和血红蛋白水平降低有关。
COP 和继发性 OP 患者的临床和影像学表现相似且无特异性。虽然某些实验室异常在继发性 OP 中更为常见，并且可能与预后较差相关，但这些异常可能是由基础疾病引起的。COP 和继发性 OP 的治疗反应、复发率和死亡率相似。
