Department of Respiratory Medicine, National Hospital Organization, Himeji Medical Center, Himeji, Hyogo, Japan.
Department of Radiology, National Hospital Organization, Himeji Medical Center, Himeji, Hyogo, Japan.
PLoS One. 2021 Apr 1;16(4):e0249300. doi: 10.1371/journal.pone.0249300. eCollection 2021.
Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic pattern of acute lung involvement with intra-alveolar fibrin deposition. However, the clinical significance of the pathological findings of AFOP remains unclear. This study aimed to explore the clinical significance of AFOP through a comprehensive clinical examination.
The medical records of patients with lung diseases accompanied by the pathological finding of intra-alveolar organization between January 2010 and December 2019 were retrospectively reviewed. The clinical and radiological findings were compared between the groups with and without the histologic pattern of AFOP.
We identified 34 patients with AFOP (AFOP group) and 143 without AFOP (non-AFOP group). The underlying diseases of the AFOP group were as follows: 19 patients had cryptogenic organizing pneumonia (OP), 5 had connective tissue diseases, 3 had radiation pneumonitis, 3 had chronic eosinophilic pneumonia, 2 had myelodysplastic syndromes, and 2 had drug-induced pneumonia. Fever was more common, the time from symptom onset to biopsy was shorter, and the serum C-reactive protein level was higher in the AFOP group than in the non-AFOP group. On high-resolution computed tomography, 85% of patients had OP pattern, and halo sign was more common in the AFOP group. Corticosteroids were effective in 94% of the patients in the AFOP group; however, recurrences were more frequent, and a higher corticosteroid dose was needed during recurrence.
AFOP might be an early phase of a histologic pattern associated with known etiologies. In addition, it could be a marker indicating intense inflammatory diseases with a tendency of recurrence.
急性纤维蛋白性和机化性肺炎（AFOP）是一种罕见的肺泡内纤维蛋白沉积为主的急性肺受累的组织学模式。然而，AFOP 的病理表现的临床意义仍不清楚。本研究旨在通过全面的临床检查探讨 AFOP 的临床意义。
回顾性分析 2010 年 1 月至 2019 年 12 月间伴有肺泡内组织病理学表现的肺部疾病患者的病历资料。比较有和无 AFOP 组织学模式患者的临床和影像学表现。
共纳入 34 例 AFOP 患者（AFOP 组）和 143 例无 AFOP 患者（非-AFOP 组）。AFOP 组的基础疾病如下：19 例为隐源性机化性肺炎（OP），5 例为结缔组织疾病，3 例为放射性肺炎，3 例为慢性嗜酸性粒细胞性肺炎，2 例为骨髓增生异常综合征，2 例为药物性肺炎。AFOP 组发热更为常见，从症状出现到活检的时间更短，血清 C 反应蛋白水平更高。高分辨率计算机断层扫描显示，85%的患者表现为 OP 模式，AFOP 组更常见晕征。94%的 AFOP 组患者对皮质类固醇有效；然而，复发更为频繁，且在复发时需要更高的皮质类固醇剂量。
AFOP 可能是一种与已知病因相关的组织学模式的早期阶段。此外，它可能是一种强烈炎症性疾病的标志物，具有复发倾向。
