Cryptogenic and Secondary Organizing Pneumonia Clinical Presentation, Radiographic Findings, Treatment Response, and Prognosis
Cryptogenic and Secondary Organizing Pneumonia Clinical Presentation, Radiographic Findings, Treatment Response, and Prognosis
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DOI：
10.1378/chest.10-0883
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发表时间：
2011-04-01
期刊：
影响因子：
9.6
通讯作者：
Polychronopoulos, Vlasis
中科院分区：
文献类型：
--
作者：
Drakopanagiotakis, Fotios;Paschalaki, Koralia;Polychronopoulos, Vlasis
背景：机化性肺炎（OP）是一种独特的临床和病理实体。这种情况可能是隐源性 (COP) 或继发于其他已知原因（继发性 OP）。在本研究中，我们回顾了来自两家教学医院的 COP 和继发性 OP 患者的相关特征。方法：对 61 例经活检证实的 OP 患者的病历进行回顾性分析。 40 名患者被诊断为 COP，21 名患者被诊断为继发性 OP。对临床表现、放射学研究、肺功能测试 (PFT)、实验室数据、BAL 结果、治疗和结果进行了分析。结果：就诊时的平均年龄为 60.46 +/- 13.57 岁。不适、咳嗽、发烧、呼吸困难、双侧肺泡浸润和限制性模式是最常见的症状和表现。 43.8% 的 OP 患者观察到 BAIL 淋巴细胞增多。随访1年后复发率和死亡率分别为37.8%和9.4%。院内死亡率为5.7%。 COP 和继发性 OP 患者的临床表现和影像学结果没有显着差异。在继发性 OP 患者中观察到混合 PFT 模式（阻塞性和限制性生理学）以及血清钠、血清钾、血小板、白蛋白、蛋白质和 pH 值较低的血液水平。继发性 OP 患者中肌酐、胆红素、Paco(2) 和 BAL 的血液水平较高，淋巴细胞也更常见。 COP 和继发性 OP 患者之间的复发率或死亡率没有差异。 1 年死亡率与红细胞沉降率升高、低白蛋白和低血红蛋白水平相关。结论：COP 和继发性 OP 患者的临床和影像学表现相似且非特异性。尽管某些实验室异常在继发性 OP 中更为常见，并且可能与较差的预后相关，但它们很可能是由潜在疾病引起的。 COP 和继发性 OP 具有相似的治疗反应、复发率和死亡率。胸部 2011； 139(4):893-900
Background: Organizing pneumonia (OP) is a distinct clinical and pathologic entity. This condition can be cryptogenic (COP) or secondary to other known causes (secondary OP). In the present study, we reviewed the features associated with COP and secondary OP in patients from two teaching hospitals.Methods: The medical records of 61 patients with biopsy-proven OP were retrospectively reviewed. Forty patients were diagnosed with COP and 21 patients with secondary OP. The clinical presentation, radiographic studies, pulmonary function tests (PFTs), laboratory data, BAL findings, treatment, and outcome were analyzed.Results: The mean age at presentation was 60.46 +/- 13.57 years. Malaise, cough, fever, dyspnea, bilateral alveolar infiltrates, and a restrictive pattern were the most common symptoms and findings. BAIL lymphocytosis was observed in 43.8% of patients with OP. The relapse rate and mortality rate after 1 year of follow-up were 37.8% and 9.4%, respectively. The in-hospital mortality was 5.7%. The clinical presentation and radiographic findings did not differ significantly between patients with COP and secondary OP. A mixed PFT pattern (obstructive and restrictive physiology) and lower blood levels of serum sodium, serum potassium, platelets, albumin, protein, and pH were observed among patients with secondary OP. Higher blood levels of creatinine, bilirubin, Paco(2) and BAL., lymphocytes were also more common among patients with secondary OP. There were no differences in the relapse rate or mortality between patients with COP and secondary OP. The 1-year mortality correlated with an elevated erythrocyte sedimentation rate, low albumin,, and low hemoglobin levels.Conclusions: The clinical and radiographic findings in patients with COP and secondary OP are similar and nonspecific. Although certain laboratory abnormalities are more common in secondary OP and can be associated with worse prognosis, they are likely due to the underlying disease. COP and secondary OP have similar treatment response, relapse rates, and mortality. CHEST 2011; 139(4):893-900