Radzikowska Elzbieta, Fijolek Justyna
III Department of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
Front Med (Lausanne). 2023 Apr 20;10:1146782. doi: 10.3389/fmed.2023.1146782. eCollection 2023.
Cryptogenic organizing pneumonia (COP) is a form of idiopathic interstitial pneumonia that results from the pulmonary reaction to various unidentified injuries. Secondary organizing pneumonia is diagnosed when the triggering factor has been identified; it is mainly caused by infections, toxic substance exposure, drugs, connective tissue diseases, malignancies, autoimmune diseases, bone marrow, or organ transplantation, and radiotherapy. There has been an increase in the number of reports of drug-induced organizing pneumonia (OP). New biological therapies, interferon, monoclonal antibodies, anti-interleukin antibodies, and PD1/PDL-1 inhibitors may induce this specific pulmonary reaction. The classical form of COP is usually subacute and does not manifest as severe disease. Patients maintain sufficient respiratory function, and treatment with steroids is usually effective. Several specific forms of OP (e.g., the cicatricial variant or acute fibrinous type) have distinct clinical and histological features, require higher doses of immunosuppressive drugs, and have a worse prognosis. In the era of administering steroid-sparing therapies for the treatment of interstitial lung diseases, connective tissue dases, and other conditions, it is important to emphasize this type of therapy for patients with COP.
隐源性机化性肺炎（COP）是特发性间质性肺炎的一种形式，由肺部对各种不明损伤的反应引起。当触发因素已被确定时，可诊断为继发性机化性肺炎；其主要由感染、接触有毒物质、药物、结缔组织疾病、恶性肿瘤、自身免疫性疾病、骨髓或器官移植以及放疗引起。药物性机化性肺炎（OP）的报告数量有所增加。新型生物疗法、干扰素、单克隆抗体、抗白细胞介素抗体和PD1/PDL-1抑制剂可能会诱发这种特定的肺部反应。COP的典型形式通常为亚急性，不会表现为严重疾病。患者保持足够的呼吸功能，使用类固醇治疗通常有效。几种特定形式的OP（如瘢痕性变体或急性纤维素型）具有独特的临床和组织学特征，需要更高剂量的免疫抑制药物，且预后较差。在为治疗间质性肺病、结缔组织疾病和其他病症而采用糖皮质激素节省疗法的时代，强调对COP患者采用这种类型的疗法很重要。
