社区获得性肺炎与与气道内肿瘤相关的阻塞后肺炎的比较。

Comparison between community-acquired pneumonia and post-obstructive pneumonia associated with endobronchial tumors.

机构信息

Department of Respiratory and Critical Care Medicine, Affiliated Yueqing Hospital of Wenzhou Medical University, Wenzhou, 325600, Zhejiang, China.

Department of Oncology, Wenzhou Central Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.

出版信息

BMC Pulm Med. 2024 Nov 28;24(1):589. doi: 10.1186/s12890-024-03409-8.

DOI:10.1186/s12890-024-03409-8

PMID:39609797

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11606229/

Abstract

BACKGROUND

Endobronchial tumors can infiltrate the bronchial wall or protrude into the bronchial lumen, causing post-obstructive pneumonia (POP). Differentiating between POP and community-acquired pneumonia (CAP) is challenging due to similar clinical, laboratory, and imaging findings, which can delay the diagnosis and treatment of endobronchial tumors.

METHODS

We compared general demographic information, laboratory test results, lung CT images, bronchoscopic observations, pathological findings between the POP group and the CAP group.

RESULTS

(1) The POP group consisted mainly of older individuals (mean age 69 vs. 56 years; P < 0.05), males (93.4% vs. 47.1%; P < 0.05), and smokers (67.2% vs. 14.7%; P < 0.05). Clinical symptoms varied, with chest pain (23.0% vs. 11.8%; P < 0.05) and hemoptysis (26.2% vs. 10.8%; P < 0.05) more prevalent in the POP group. MSCT showed that bronchial wall thickening, bronchial stenosis, occlusion, obstructive emphysema, mucoid impaction, and endobronchial shadows occurred more frequently in POP, while consolidation and exudation shadows were predominant in CAP (P < 0.05). (2) In the POP group, neoplasms were the most frequent bronchoscopic findings (57 cases, 93.44%), especially in the upper lungs. Squamous cell carcinoma was the primary pathological type (52 cases, 85.25%). The average delay in diagnosing endobronchial tumors was 214.8 days. In the POP group, 34 cases (55.74%) had abnormal CT images in the past and did not undergo bronchoscopy, resulting in delayed diagnosis. (3) Factors such as gender, age, bronchial occlusion, stenosis, mucus embolism, and intraluminal shadow were determined to be independent risk factors for endobronchial tumors (P < 0.05 and OR > 1).

CONCLUSIONS

Endobronchial tumors combined with POP are easily misdiagnosed as CAP in the early stage. Factors like bronchial occlusion, stenosis, mucus embolism, and intraluminal shadows on MSCT are significant independent risk factors for these tumors, indicating the need for early bronchoscopy.

摘要

背景

支气管内肿瘤可浸润支气管壁或向支气管腔内突出，导致阻塞后肺炎（POP）。由于临床、实验室和影像学表现相似，鉴别 POP 和社区获得性肺炎（CAP）具有挑战性，这可能会延迟支气管内肿瘤的诊断和治疗。

方法

我们比较了 POP 组和 CAP 组的一般人口统计学信息、实验室检查结果、肺部 CT 图像、支气管镜观察结果和病理发现。

结果

（1）POP 组主要由老年人（平均年龄 69 岁比 56 岁；P<0.05）、男性（93.4%比 47.1%；P<0.05）和吸烟者（67.2%比 14.7%；P<0.05）组成。临床症状多样，胸痛（23.0%比 11.8%；P<0.05）和咯血（26.2%比 10.8%；P<0.05）在 POP 组更为常见。MSCT 显示，支气管壁增厚、支气管狭窄、闭塞、阻塞性肺气肿、黏液嵌塞和支气管内阴影在 POP 中更为常见，而实变和渗出阴影在 CAP 中更为常见（P<0.05）。（2）在 POP 组中，肿瘤是最常见的支气管镜下发现（57 例，93.44%），尤其是在上肺。鳞状细胞癌是主要的病理类型（52 例，85.25%）。平均延迟诊断支气管内肿瘤 214.8 天。在 POP 组中，34 例（55.74%）过去 CT 图像异常但未行支气管镜检查，导致诊断延迟。（3）性别、年龄、支气管闭塞、狭窄、黏液栓塞和管腔内阴影等因素被确定为支气管内肿瘤的独立危险因素（P<0.05 和 OR>1）。