Cordier J F, Loire R, Brune J
Department of Pneumology, Hôpital Cardio-vasculaire et Pneumologique Louis Pradel, Université Claude Bernard, Lyon, France.
Chest. 1989 Nov;96(5):999-1004. doi: 10.1378/chest.96.5.999.
Bronchiolitis obliterans organizing pneumonia (BOOP) is a pathologic finding common to various injuries to the lung of either definite or idiopathic etiology. Since the presentation of patients with idiopathic BOOP varies, we studied 16 patients with BOOP on pulmonary histology to define more distinct and homogeneous clinical and imaging profiles of idiopathic BOOP. We distinguished three groups of patients: group 1 (n = 4), with multiple patchy migratory pulmonary involvement of the pneumonia type. Their clinical course was subacute, with cough, fever, weight loss, mild dyspnea, and increased ESR. Chest x-ray film and CT scan showed multiple alveolar opacities. All patients completely recovered with corticosteroid therapy but relapsed when therapy was stopped too rapidly. Group 2 (n = 5) had solitary pulmonary involvement of the pneumonia type occurring in a similar clinical context. Since carcinoma was suspected, they underwent surgical excision of the pneumonic area and recovered without relapse. Group 3 patients (n = 7) presented with diffuse pulmonary involvement of the interstitial lung disease type. They had more progressive onset of more severe dyspnea, crackles heard over all lung surfaces, and interstitial opacities with or without alveolar opacities on chest imaging. Improvement with corticosteroid therapy was obtained in only three patients. In all three groups, lung function test results showed a restrictive pattern. The obstructive pattern characteristic of pure bronchiolitis obliterans was found in none. BAL showed a mixed pattern (increase of both lymphocytes and polymorphonuclear cells) in the patients of the first two groups. Thus, we distinguished three characteristic clinical and imaging profiles in patients with idiopathic BOOP: multiple patchy pneumonia, solitary pneumonia, and diffuse interstitial lung disease. These profiles are so different that they should be distinguished in clinical studies of idiopathic BOOP.
闭塞性细支气管炎伴机化性肺炎（BOOP）是一种病理表现，常见于各种明确病因或特发性病因导致的肺损伤。由于特发性BOOP患者的临床表现各异，我们对16例经肺组织学确诊为BOOP的患者进行了研究，以明确特发性BOOP更具特征性且更为一致的临床和影像学特征。我们将患者分为三组：第1组（n = 4），表现为多灶性、游走性的肺炎型肺部受累。其临床病程呈亚急性，有咳嗽、发热、体重减轻、轻度呼吸困难及血沉增快。胸部X线片和CT扫描显示多发肺泡性实变。所有患者经皮质类固醇治疗后完全康复，但治疗过早停药时会复发。第2组（n = 5），在类似临床情况下出现单发的肺炎型肺部受累。由于怀疑为癌，他们接受了肺炎区域的手术切除，术后康复且无复发。第3组患者（n = 7），表现为弥漫性的间质性肺病型肺部受累。他们起病更为隐匿，呼吸困难更严重，双肺可闻及湿啰音，胸部影像学检查显示有间质实变，可伴有或不伴有肺泡实变。仅3例患者经皮质类固醇治疗后有所改善。在所有三组中，肺功能检查结果均显示为限制性通气模式。未发现有单纯闭塞性细支气管炎特征性的阻塞性通气模式。前两组患者的支气管肺泡灌洗显示为混合模式（淋巴细胞和多形核细胞均增多）。因此，我们在特发性BOOP患者中区分出三种特征性的临床和影像学特征：多灶性斑片状肺炎、单发肺炎和弥漫性间质性肺病。这些特征差异显著，在特发性BOOP的临床研究中应予以区分。
