Hayasaka M, Honda T, Hachiya T, Morita M, Fujimoto K, Kubo K, Kobayashi T, Sekiguchi M, Kobayashi O
First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Jun;32(6):531-7.
We studied four patients with idiopathic Bronchiolitis Obliterans Organizing Pneumonia (BOOP) diagnosed by open lung biopsy. All of four presented with acute onset and a rapid course with progressive dyspnea. Their chest X-ray films showed ground-glass opacities with reduced volumes in the bilateral lower lobes. Their chest CT revealed marked increases in lung density with air bronchograms. Radiologically, it was difficult to distinguish these cases from patients with acute interstitial pneumonia. Histologically, in the uninflated specimens, the collapse of alveoli and alveolar spaces filled with foamy macrophages and proteinous exudates were observed. The organizing tissues were present predominantly in the alveolar ducts, but varied in extent among cases. We considered the reduced lung volumes on chest X-ray films and the marked increases in lung density on chest CT to reflect alveolar collapse. Proliferation of type II pneumocytes was remarkable in all cases, but reactivity to antisurfactant protein-A antibody staining was decreased in the collapsed alveoli. It was suggested that the alveolar collapse was caused, in part, by decreased pulmonary surfactant in addition to obstruction of the alveolar ducts. The rapid responses to of these patients corticosteroid therapy may be due to improvement of the alveolar collapse.
我们研究了4例经开胸肺活检确诊的特发性闭塞性细支气管炎并机化性肺炎（BOOP）患者。这4例患者均急性起病，病程进展迅速，伴有进行性呼吸困难。他们的胸部X线片显示双下肺野磨玻璃样阴影伴肺容积减小。胸部CT显示肺密度显著增加伴空气支气管征。从放射学角度，很难将这些病例与急性间质性肺炎患者区分开来。组织学上，在未充气的标本中，观察到肺泡塌陷，肺泡腔内充满泡沫状巨噬细胞和蛋白质渗出物。机化组织主要存在于肺泡管，但不同病例的范围有所不同。我们认为胸部X线片上肺容积减小以及胸部CT上肺密度显著增加反映了肺泡塌陷。所有病例中II型肺泡上皮细胞增殖均显著，但塌陷肺泡中抗表面活性蛋白A抗体染色的反应性降低。提示肺泡塌陷部分是由于肺泡管阻塞外，还与肺表面活性物质减少有关。这些患者对皮质类固醇治疗的快速反应可能归因于肺泡塌陷的改善。
