急性纤维素性机化性肺炎3例病理特征及文献复习

doi:10.6040/j.issn.1671-7554.0.2022.1287

摘要/Abstract

摘要： 目的探讨急性纤维素性机化性肺炎(AFOP)的临床症状、影像学表现、病理学特征、治疗方案及预后,提高临床诊治能力。方法收集3例AFOP患者的临床资料,并复习国内外相关文献报道。结果本组3例AFOP属特发性亚急性型,病理组织学可见肺泡腔多量纤维素性渗出物沉积,呈现“均质嗜酸性纤维素球”等典型表现,3例均对糖皮质激素治疗敏感。联合本例共纳入86例进行分析,其中男46例,女40例,平均(53.8±15.9)岁,35例无明确诱发因素,51例为继发性AFOP,合并自身免疫系统和血液系统疾病最多见,最常见的症状是发热、呼吸困难和咳嗽,实变是最常见的影像学表现,其次是磨玻璃密度影和结节。多数患者通过经皮肺穿刺或经支气管镜肺活检等微创手段确诊。治疗主要应用激素,但治疗方案最终取决于病因和疾病严重程度。结论 AFOP是一种罕见的非感染性的肺部疾病,临床表现和影像学改变缺乏特异性。病理学有其独特组织学表现,诊断时需与其他肺部损伤性疾病相鉴别。

关键词: 急性纤维素性机化性肺炎, 组织学, 糖皮质激素

Abstract: Objective To investigate the clinical symptoms, imaging manifestations, pathological features, treatment and prognosis of acute fibrinous and organizing pneumonia(AFOP)to enhance the diagnosis and treatment of this disease. Methods The clinical data of 3 AFOP patients were collected, and the relevant literature reports were reviewed. Results All of the 3 cases were idiopathic and subacute. Pathological histology showed intra-alveolar fibrin deposition forming eosinophilic fibrin “balls”. All patients had a good clinical response to glucocorticoid therapy. Clinical data of 86 reported AFOP cases including 46 males and 40 females(aged 53.8±15.9 years)were also analyzed. No risk or predisposing factors were observed in 35 cases, while the other 51 cases were secondary AFOP. Autoimmune and hematological diseases were the most common comorbidity. Most common symptoms were dyspnea, cough and fever. Consolidation was the most common imaging pattern, followed by ground-glass opacity and nodules. Most cases were confirmed by minimally invasive procedures including percutaneous lung puncture biopsy or transbronchial lung biopsy. Corticosteroids were the main drug treatment, but the final options depended on the etiology and severity of disease. Conclusion AFOP is a rare noninfectious pulmonary disease with a lack of specificity in clinical presentation and imaging. Pathology has unique histological features, and should be differentiated from other lung injury diseases.

Key words: Acute fibrinous and organizing pneumonia, Histology, Glucocorticoid

中图分类号:

R365

杨庆婵,王咏梅,王承志. 急性纤维素性机化性肺炎3例病理特征及文献复习[J]. 山东大学学报 (医学版), 2023, 61(6): 58-64.

YANG Qingchan, WANG Yongmei, WANG Chengzhi. Pathological characteristics of 3 cases of acute fibrinous and organizing pneumonia and literature review[J]. Journal of Shandong University (Health Sciences), 2023, 61(6): 58-64.

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