Clinical And Pathological Analysis Of 99 Cases Of Organizing Pneumonia

Introduction:Organizing pneumonia(OP)on the pathology of respiratory bronchioles and alveolar ducts and alveoli fibroblasts,fibroblasts,collagen formation of granulation tissue and fibrosis exudates.According to underlying causes,it can be classified as cryptogenic organizing pneumonia(COP)and secondary organizing pneumonia(SOP).As the development of diagnosis and treatment of OP,incidence of OP increased.But clinical manifestations and laboratory finding are usually non-specific,and it’s difficult to identify with other lung diseases,leading misdiagnosis clinically.Relapse and residual in COP are big challenges.This study aims to understand the clinical features of OP and all subsets,compare difference of subsets of OP characteristics.Methods:99 patients diagnosed as OP pathologically between January 2017 and December 2018 in our Hospital were included into this study.Patients’data were evaluated retrospectively from the medical record,including ways of diagnosis,clinical manifestation,laboratory findings,pulmonary function,radiology and follow-up.Summarize the etiology and clinical characteristics of subsets of OP,compare the difference of COP and SOP,next compare COP and infection secondary organizing pneumonia(ISOP).Results:(1)99 patients diagnosed as OP pathologically were recruited.Diagnostic way is surgical lung biopsy(lobectomy,wedge resection)in 50 cases,autopsy in 2 cases,percutaneous needle lung biopsy in 49 cases,transbronchial lung biopsy in 1 case.And 3 patients get percutaneous needle lung biopsy and surgical lung biopsy.27 patients were defined as COP,73 were SOP.Infection,cancer,granulomatous lesions,drugs,radiotherapy,connective tissue disease,hypersensitivity pneumonitis,leukemia and gangrenous pyoderma were the underlying causes of OP.Infection is most common in SOP for 43%.(2)The symptoms of OP were cough and expectoration,fever,dyspnea.They had elevated infection biomarkers.Some patients’autoantibodies were abnormal.The lung function was restrictive ventilatory dysfunction or mixed ventilatory dysfunction,and diffuse dysfunction.59.7%patients had hypoxemia.The most common Images were consolidation,ground-glass opacity and nodule.(3)51 patients were followed up,9 cases(17.6%)relapsed,and 6 cases(11.8%)died.Recurrence and death were common in patients of COP and ISOP.3 cases of COP relapsed when reducing dose of glucocorticoid.Occurrence of acute respiratory failure is relative to death of COP.ISOP patients with recurrence and death are associated with primary infection.(4)Comparative analysis of patients with COP and ISOP,ISOP patients’ sputum ratio is significantly higher than COP(p<0.05),ISOP patients’ white blood cells,neutrophils,D dimer were significantly higher than COP(p<0.05).FEV1/predict percentage of lung function in COP was higher than SOP(p<0.05).COP was more likely to show the ground glass shadow and subpleural distribution(p<0.05)than ISOP.Pathologically ISOP can appear on lung structure damage,necrosis,abscess,occlusive vasculitis and other infectious characteristics,be corresponding to the image on the empty,consolidation and air bronchogram.Conclusion:(1)Causes of OP patients in Beijing hospital are mainly infection,tumor,granulomatous inflammation,connective tissue diseases,radiotherapy,drugs.The most common cause is infection.(2)From the follow-up COP and ISOP had more recurrence and death than other subsets of OP.COP often relapse when reducing glucocorticoids,and treatment of ISOP is mainly anti-infection therapy.(3)Patients with COP see more ground glass shadow and subpleural distribution in image,while patients with ISOP mainly show elevated infection indexes,FEV1 decline in lung function,and pathologically lung structure destruction and necrosis.