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ENGLISH ABSTRACT
隐源性机化性肺炎及结缔组织病相关性机化性肺炎的临床及影像特点分析
沈威
李慧
代静泓
苗立云
肖永龙
曹敏
黄妹
曹孟淑
孟凡青
蔡后荣
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1001-0939.2015.09.010
Analysis for differences in clinical and radiologic findings between patients with cryptogenic organizing pneumonia and connective tissue disorder related organizing pneumonia
Shen Wei
Li Hui
Dai Jinghong
Miao Liyun
Xiao Yonglong
Cao Min
Huang Mei
Cao Mengshu
Meng Fanqing
Cai Hourong
Authors Info & Affiliations
Shen Wei
Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China
Li Hui
Dai Jinghong
Miao Liyun
Xiao Yonglong
Cao Min
Huang Mei
Cao Mengshu
Meng Fanqing
Cai Hourong
·
DOI： 10.3760/cma.j.issn.1001-0939.2015.09.010
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摘要

目的探讨隐源性机化性肺炎(COP)和结缔组织病相关性机化性肺炎(CTD–OP)的临床表现和影像学特点。

方法回顾性分析南京鼓楼医院2005–2013年52例经病理证实的机化性肺炎资料，其中男24例，女28例，平均年龄(55±11)岁，30例为COP，22例为CTD–OP。

结果CTD–OP的原发病多为干燥综合征、皮肌炎/多发性肌炎、类风湿关节炎，两组患者在咳嗽、咳痰、咯血、呼吸困难、发热及胸痛等临床表现方面无明显差别，CTD–OP组女性患者比例(17/22)明显高于COP组(11/30， P<0.01)，两组肺功能损害均以限制性通气功能障碍为主，组间比较差异无统计学意义( P>0.05)；两组ANA阳性率有明显差异(CTD–OP组14/22，COP组3/30， P<0.01)；两组影像学改变无明显差异，均以斑片状实变影、条索状影及磨玻璃影最常见，部分患者表现为孤立性块状影，少量患者伴有胸腔积液；网格样改变少见；分布均以两肺胸膜下最常见，可沿支气管血管束分布。

结论COP和CTD–OP患者的呼吸道症状和影像学表现无明显差异，CTD–OP组中女性患者比例、ANA阳性率、关节痛及皮疹等肺外症状明显高于COP组。

隐源性机化性肺炎;结缔组织病相关性机化性肺炎;临床表现;高分辨率CT
ABSTRACT

ObjectiveTo investigate the difference in clinical features and radiologic findings between patients with cryptogenic organizing pneumonia(COP) and connective tissue disorder related organizing pneumonia (CTD-OP).

MethodsA total of 30 subjects with COP and 22 subjects with CTD-OP collected from 2005 to 2013 were retrospectively reviewed in the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, and the diagnosis of all patients were confirmed by lung biopsy.

ResultsThe common underlying diseases in patients with CTD-OP were Sjogren syndrome(SS), poly-/dermatomyositis(PM/DM), rheumatoid arthritis (RA). There were no significant differences in clinical manifestations between CTD-OP and COP. Compared with COP patients, the proportion of female patients was higher in CTD-OP. Higher positive rate for ANA was found in CTD-OP group(CTD-OP: 63.6%; COP: 10.0%; P<0.01). There were no significant differences in parameters of lung function between CTD-OP and COP. As to radiological findings, the most common patterns were multiple patchy, linear shadows and ground-glass opacity. Some patients showed solitary nodule or consolidation and pleural effusion. Reticular shadow was a rare pattern among these patients. Most lesions were under the pleura and/or around the bronchus.

ConclusionsThere are no significant differences in clinical and radiologic manifestations between COP and CTD-OP, except that the proportion of women and ANA positive rate were higher in CTD-OP.

Cryptogenic organizing pneumonia;Connective tissue disease, organizing pneumonia;Clinical features;High-resolution CT
Cai Hourong, Email: mocdef.3ab613102gnoruohiac
Copyright by Chinese Medical Association
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All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

沈威,李慧,代静泓,等. 隐源性机化性肺炎及结缔组织病相关性机化性肺炎的临床及影像特点分析[J]. 中华结核和呼吸杂志,2015,38(9)：669-674.

DOI:10.3760/cma.j.issn.1001-0939.2015.09.010

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机化性肺炎(OP)是一种独立的临床病理实体，以细支气管、肺泡管、肺泡腔内肉芽组织栓形成为病理特征 [ 1 ]。OP可以分为原发性OP和继发性OP，原发性OP又称为隐源性机化性肺炎(COP)，是特发性间质性肺炎中较为常见的类型，对激素治疗敏感、预后相对较好。而继发性OP的病因有多种，包括结缔组织疾病(CTD)、感染、恶性肿瘤、药物、放射性损伤、器官移植等 [ 2 , 3 ]，其中CTD相关性OP(CTD–OP)是继发性OP较为常见的类型。尽管大多数CTD相关性间质性肺疾病的预后好于相应病理类型的特发性间质性肺炎，但有文献报道CTD–OP较COP患者预后差、复发率更高 [ 4 ]，提示同一病理实体在CTD和特发性间质性肺疾患者群中的临床进程存在差异。对于CTD–OP与COP的临床特点和影像学改变的异同，目前国内少有文献报道。本研究回顾性分析病理确诊的COP以及CTD–OP临床和影像资料，比较分析COP和CTD–OP在临床特点、影像表现方面的差异，提高临床医生对OP诊断和治疗的认识。
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备注信息
A
蔡后荣，Email： mocdef.3ab613102gnoruohiac
B
国家自然科学基金 (81470253)
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