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目的:探析隐源性机化性肺炎肺部CT的影像特征以及病理特征。方法:选择我院于2013年2月至2014年2月期间收治的22例机化性肺炎患者作为研究对象进行回顾性分析,根据患者临床资料进行分析,了解患者的基本资料以及吸烟史,了解患者病情的发生以及演变过程、病变时间以及临床症状,分析患者的降钙素元、C反应蛋白、生化指标(主要包括肝肾功能以及肿瘤标志物)、结核三项、不吸氧状态下的动脉血气分析结果、PPD、氧合指数、血沉以及血常规等,分析患者治疗前后的影像学检查结果以及出院后复查的胸部HRCT资料,分析治疗以及副作用情况,比如所用药物的种类、用药时间、给药途径以及减药规律,可能导致患者发病的诱因,比如药物、感染、过敏以及放射等。结果:22例患者中,隐源性机化性肺炎的确诊患者为16例,其中吸烟的患者为9例,所占比例为56.25%。16例患者在入院时外周血白细胞计数的检结果为正常,但是存在弥散功能障碍的情况,高分辨率的CT检查显示,斑片状影、形态不规则的实变影以及双肺多发的患者有13例(81.25%),并且肺部边界较为模糊,密度不均,在光学显微镜下的表现均为肌成纤维细胞和疏松结缔组织填塞、细支气管肺泡内存在纤维细胞、肺泡腔等,并且出现少量纤维细胞增生的情况,部分伴有炎症细胞浸润现象,符合机化性肺炎的改变。结论:隐源性机化性肺炎临床表现以及影像学表现的特异性不够高,因此非常容易导致误诊。为了提高该病的确诊率,需要同时结合患者的病理学表现、影像学资料以及临床表现进行诊断。
Objective: To explore the imaging characteristics and pathological features of lung CT in patients with cryptogenic pneumonia. Methods: Twenty-two patients with PCA who were treated in our hospital from February 2013 to February 2014 were retrospectively analyzed. According to the clinical data of the patients, we analyzed the basic data of the patients and the smoking history, The occurrence and course of the disease, the time of the disease and the clinical symptoms were analyzed. The levels of calcitonin, C-reactive protein, biochemical parameters (mainly including liver and kidney function and tumor markers), tuberculosis, Arterial blood gas analysis results, PPD, oxygenation index, erythrocyte sedimentation rate and blood routine, analysis of imaging results of patients before and after treatment and post-discharge chest CTCT analysis, treatment and side effects, such as the type of drug used, medication time, The route of administration as well as the law of drug reduction may lead to the onset of the patient’s causes, such as drugs, infections, allergies and radiation. Results: Of the 22 patients, 16 were diagnosed as cryptogenic organic pneumonia, of which 9 were smoking, accounting for 56.25%. 16 patients with normal peripheral blood leukocyte count at admission, but the presence of diffuse dysfunction, high-resolution CT examination showed patchy shadow, irregular morphological real shadow and patients with multiple lung disease 13 cases (81.25%), and the lung border is more blurred, the density of uneven, the performance of optical microscopy were myofibroblasts and loose connective tissue packing, bronchial alveoli presence of fibroblasts, alveolar cavity, etc., and A small amount of fibroblast proliferation occurred, some accompanied by inflammatory cell infiltration, in line with the change of opportunistic pneumonia. Conclusion: The clinical manifestations of cryptogenic organic pneumonia and the poor specificity of imaging findings are very easy to cause misdiagnosis. In order to improve the diagnosis rate of the disease, it needs to be combined with the patient’s pathological findings, imaging data and clinical manifestations for diagnosis.