急性纤维素性并机化..VIP免费

·892·生堡笙璧塑哩咝盘查!Q!Q生!!旦筮塑鲞筮!!塑￡堑!』立壁丝曼!型!望堡：望!!!翌墅!垫!壁：!!!：箜：坠：!兰急性纤维素性并机化性肺炎一例及文献复习张捷方秋红冯瑞娥马迎民曹或王仁责【摘要】目的提高对急性纤维索性并机化性肺炎(AFOP)临床与病理特点的认识。方法分析2009年12月收治的I例AFOP患者临床资料及诊治经过，并复习相关文献。结果患者男，73岁，临床表现为发热、咳嗽、咳少量门痰，伴有呼吸闲难逐渐加重，胸部CT示双肺多发团片状影和结节影。经抗乍素及抗真菌治疗无效，呼吸困难加重，胸部CT爪双肺团片状影和结节影增多。B超引导卜．经皮肺穿刺活检病理表现为肺泡间隔略增宽，可见淋巴细胞和浆细胞浸润，肺泡腔内nJ见纤维母细胞呈息肉状延伸(机化)伴纤维素样红染物质，未见中性粒细胞和嗜酸粒细胞浸润，病变符合AFOP。经糖皮质激素治疗后症状很快缓解，胸部影像学改变明显好转。小例的临床特征与文献报道的AFOP亚急性型卡H一致。结论AFOP的临床特征缺乏特异性，主要瞿急性肺损伤的临床表现，确t诊断主要依赖组织病理学检杳。几前尚无统一的治疗方案．糖皮质激素是主要治疗措施，但J￡剂虽和疗程也未明确，Ⅱ在糖皮质激素治疗减情的过程中还有复发的町能。【关键词】肺疾病，I'阿J质性；急性纤维索性并机化性肺炎；隐源'I'I-4，L化傩肺炎Acutefibrinousandorgamzingpneumonia：acasereportandreviewoftheliteratureZHANGJie’．FANGQiu一}m昭，FENGRui—e。MAYing—min．CAt)Yu．WANGRen—gui．女DepartmentofRespiratoryMedicine．BeiingShijitanHospital。Beijinglo【)038，ChinaCorrespondingauthor：FANGQiu-hong，DepartmentofRespiratoryMedicine，Be咖ngShijitanHospital，Beqing100038。China。Email：qiuhongfang@hotmaiLcorn【Abstract】ObjectiveTobetterunderstandtheclinicalandpathologicalcharacteristicsofacutefibrinousandorganizingpneumonia(AI：OI’)．MethodsAc日kqediagnosedwithAFOPwasreportedandtherelatedliteraturewasreviewed．ResultsA73year·oldmanpresentingwithfever，coughwithsmallamountofwhitesputumandgraduallyworseningdyspneawasadmittedtothishospital．ChestCTscanshowedbilateralmultiplenedulesandpatchyinfiltrates．Treatmentincludinganti．bacterialandanti．fungaldmgswasinitiated．butnoimprovementwasobserved．ThedyspneadeterioratedandrepeatedchestCTshowedanincreaseofthenodulesandthepatchyinfiltrates．Uhrasoundguidedpercutaneouslungbiopsywasperformedandthepathologicalexaminationrevealedslightlywidenedalveolarsepta．1ymphocyteandplasmacellinfiltrationan(1thepresenceofintra—alveolarfibrininthefo硼offibrin“balls”(organization)withinthealveolarspaces．Noneutrophilandeosinophilinfiltrationw踮detected．ThefindingWasconsistentwithAFOPCorticosteroidtherapywasstartedandthepatientshowedsignificantclinicalandradiologicalimprovement"afteracourseoftreatment．ThPpatientWasdischargedandfollowedintheoutpatientclinic．ThechestCTbecamenearlynormal'aftertreatmentwithcorticosteroidsfor1．5months．C：onclusionsThemainclinicalmanifestationsofAFOPweresimilartothoseofacutelunginjury．Diagnosiswasmadebylungbiopsy．7FhPoptimaltreatmentforAFOPhadnotbeenestablished．Therapywithcorticosteroidscouldbeattempted，butrelapsemayoccurduringtheperiodofreducingthedosageofcorticostemids．【Keywords】Lungdiseases，interstitial；Acutefibrinousandorganizingpneumonia；Cryptogenicorganizingpneumonia急性纤维素性并机化性肺炎(acutefibrinousandorganizingpneumonia，AFOP)于2002年首次报DOI：10．3760／eraa．j．issn．1001-0939．2010．12．006作者单位：100038北京l什纪坛医院呼吸科(张捷、方秋红、屿迎民，曹或)．放射科(1三仁贵)；中国医学科学院北京协和医院病理科(冯瑞娥)通信作者：力．秋红．Email：qiuho,咖s@hotmaiLm．论著．道以来。¨...