误诊为社区获得性肺炎的隐源性机化性肺炎临床分析
Clinical Analysis of Cryptogenic Organizing Pneumonia Misdiagnosed as Community-acquired Pneumonia
董学峰 1常乐 1傅金木2
作者信息
- 1. 362001 福建 泉州,泉州医学高等专科学校内科教研室
- 2. 362000 福建 泉州,泉州医学高等专科学校附属人民医院内一科
- 折叠
摘要
目的 探讨隐源性机化性肺炎(COP)的临床特点及误诊为社区获得性肺炎(CAP)的原因、防范措施.方法 回顾性分析2014 年1 月—2022 年6 月收治的初期误诊为CAP的COP 29 例的临床资料.结果 本组29 例中咳嗽20 例,咳痰12 例,胸闷9 例,活动后气促7 例,胸痛3 例;发热14 例,食欲缺乏6 例,体质量减轻5 例,乏力3 例.肺部听诊局部闻及湿啰音14 例,双肺闻及哮鸣音10 例、肺爆裂音7 例.血白细胞升高14 例,中性粒细胞升高8 例;C反应蛋白升高14 例;红细胞沉降率增快9 例.肺功能检查均提示弥散功能障碍.胸部CT检查示肺部炎性病变.29例就诊初期均诊断为CAP,予抗生素治疗效果欠佳.请上级医师会诊考虑为特殊病原体感染,加行CT引导下经皮肺穿刺活组织病理检查21 例,经支气管镜肺活组织病理检查8 例,并排除继发性机化性肺炎后确诊为COP.误诊时间(17.24±2.17)d.29 例确诊后停用抗生素并予泼尼松治疗.29 例6～12 个月后复查病情皆缓解,遂停药;停药后随访6 个月均无复发.结论 COP临床较少见,早期临床及影像学表现无特异性,易误诊为CAP.提高临床医生对COP认识,仔细鉴别诊断,动态观察患者治疗前后影像学改变,及时行诊断性治疗和病理学检查,可降低临床误诊率.
Abstract
Objective To investigate the clinical characteristics of cryptogenic organizing pneumonia(COP)and the causes and preventive measures of misdiagnosis as community-acquired pneumonia(CAP).Methods The clinical data of 29 patients with COP which was initially misdiagnosed as CAP from January 2014 to June 2022 were retrospectively analyzed.Re-sults Among the 29 cases,there were 20 cases with cough,12 cases with sputum,9 cases with chest tightness,7 cases with shortness of breath after exercise,and 3 cases with chest pain.Fever occurred in 14 cases,anorexia in 6 cases,weight loss in 5 cases and fatigue in 3 cases.Pulmonary auscultation showed local moist rales in 14 cases,wheezing in both lungs in 10 ca-ses,and crackles in both lungs in 7 cases.Leukocytes increased in 14 cases and neutrophils increased in 8 cases.C reactive protein increased in 14 cases,and erythrocyte sedimentation rate increased in 9 cases.Pulmonary function examination all in-dicated diffuse dysfunction.Chest CT examination revealed inflammatory pulmonary lesions.All the 29 cases were initially di-agnosed with CAP and responded poorly to antibiotics.Superior doctors were invited to consult and considered that the infec-tion was a special pathogen.CT-guided percutaneous biopsy of lung was performed in 21 cases,and bronchoscopic biopsy of lung was performed in 8 cases;secondary organizing pneumonia was ruled out and they were diagnosed as COP.The duration of misdiagnosis was(17.24±2.17)d.Twenty-nine cases were treated with prednisone after discontinuation of antibiotics.After 6 to 12 months,all the 29 cases were relieved,and the drug was discontinued.There was no recurrence at 6 months af-ter follow-up.Conclusion COP is rare in clinical practice,and its early clinical and imaging manifestations are nonspecific;therefore,it is more likely to be misdiagnosed as CAP.Improving clinicians＇understanding of COP,carefully performing dif-ferential diagnosis,dynamically observing imaging changes of patients before and after treatment,timely performing diagnostic treatment and pathological examination can reduce the clinical misdiagnosis rate.
关键词
隐源性机化性肺炎/误诊/社区获得性肺炎/体层摄影术,螺旋计算机/病理学检查/诊断/鉴别诊断/糖皮质激素Key words
Cryptogenic organizing pneumonia/Misdiagnosis/Community-acquired pneumonia/Tomography,spiral computed/Pathological examination/Diagnosis/Differential diagnosis/Glucocorticoids引用本文复制引用
出版年
2023
国家科技期刊平台
NSTL
万方数据