| 摘要: |
| 目的 分析新型冠状病毒感染（COVID-19）相关机化性肺炎（OP）患者的临床表现、诊断要点及治疗措施，以提高临床医师对COVID-19相关OP的认识及救治水平。方法 总结我院2例COVID-19相关OP患者的临床资料和诊治经过。检索PubMed数据库相关病例报道，归纳分析COVID-19相关OP患者的人口学特征、影像学表现、诊治过程及转归等数据。结果 从PubMed数据库共检索到45例COVID-19相关OP患者的报道，共47例患者纳入分析。47例患者年龄为25～84（59.6±13.0）岁，男35例（74.5%）、女12例（25.5%）。31例（66.0%）患者初诊COVID-19时符合重型或危重型，34例（72.3%）需呼吸支持。初诊COVID-19至临床诊断OP时间为12～68（32.3±13.5）d。20例（42.6%）患者COVID-19初始治愈出院或仅居家观察，后因症状再发入院而诊断为OP； 27例（57.4%）在诊断OP前维持住院治疗。44例（93.6%）患者CT表现为双肺多发病变，主要病变模式为实变（35例，74.5%）、磨玻璃影（31例，66.0%）、小叶间隔增厚（14例，29.8%）、条索影（14例，29.8%），28例（59.6%）患者病变呈现典型外周分布特点。45例（95.7%）患者予以糖皮质激素治疗。所有患者随访期均临床稳定。结论 COVID-19相关OP可能与COVID-19患者肺部后遗症及部分重型患者持续低氧有关，胸部CT在OP诊断中发挥重要作用。糖皮质激素治疗能取得良好预后，但如何确定最佳剂量、疗程仍需进一步临床研究。 |
| 关键词: 新型冠状病毒感染 机化性肺炎 计算机断层扫描 糖皮质激素 |
| DOI：10.16781/j.CN31-2187/R.20230549 |
| 投稿时间：2023-10-02修订日期：2023-11-28 |
| 基金项目: |
|
| Coronavirus disease 2019-associated organizing pneumonia: a report of 2 cases and review of literature |
| XU Hong,CHANG Yunqi,DU Wei,LI Weifeng,HUANG Wenjie* |
(Department of Respiratory Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, Guangdong, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the clinical manifestations, diagnosis and treatment measures of patients with coronavirus disease 2019 (COVID-19)-associated organizing pneumonia (OP), so as to improve the clinicians’ awareness and treatment of the disease. Methods The clinical data, diagnosis and treatment of 2 cases of COVID-19-associated OP from our hospital were summarized. Relevant case data were retrieved from the PubMed database, and the demographic characteristics, imaging manifestations, diagnosis and treatment process, and outcomes of patients with COVID-19-associated OP were summarized and analyzed. Results A total of 45 patients with COVID-19-associated OP were retrieved from PubMed database. A total of 47 patients were enrolled in the data analysis, and the age ranged from 25 to 84 (59.6±13.0) years old, with 35 (74.5%) males and 12 (25.5%) females. Thirty-one (66.0%) patients were diagnosed as severe or critical COVID-19, and 34 (72.3%) patients required respiratory support. The duration from initial diagnosis of COVID-19 to clinical diagnosis of OP was 12-68 (32.3±13.5) d. Twenty (42.6%) patients were initially cured and discharged or only observed at home, and then were diagnosed as OP due to recurrence of symptoms; 27 (57.4%) patients were hospitalized before diagnosis of OP. The computed tomography (CT) results of 44 (93.6%) patients showed multiple lesions in both lungs, and the main lesion patterns were consolidation (35 cases, 74.5%), ground glass opacity (31 cases, 66.0%), interlobular septal thickening (14 cases, 29.8%) and linear shadow (14 cases, 29.8%), and 28 (59.6%) cases of the lesions showed typical peripheral distribution. Forty-five (95.7%) patients were treated with glucocorticoids. All patients were clinically stable during the follow-up period. Conclusion COVID-19-associated OP may be related to the pulmonary sequelae of COVID-19 and persistent hypoxia in some severe patients. Chest CT plays an important role in the diagnosis of OP. Glucocorticoid therapy can achieve a good prognosis, but the optimal dose and course of treatment still need further clinical research. |
| Key words: coronavirus disease 2019 organizing pneumonia computed tomography glucocorticoid |
