Analysis Of Clinical Characteristics And Recurrence Factors Of Organizing Pneumonia

ObjectiveTo explore the causes of misdiagnosis of organizing pneumonia as lung cancer and pulmonary infection,and to study the influencing factors of recurrence and refractory of organizing pneumonia,so as to provide ideas for more reasonable clinical diagnosis and treatment for OP.MethodPart Ⅰ:The medical records of 38 cases of organizing pneumonia diagnosed by clinical feature-radiology-pathology in the Department of Thoracic Surgery of our hospital from April 2013 to June 2021 were analyzed retrospectively to explore the causes of misdiagnosis as lung cancer.Part Ⅱ:The medical records of 80 cases of organizing pneumonia diagnosed by clinical feature-radiology-pathology in the Department of Respiratory and Critical Care Medicine of our hospital from February 2009 to March 2021 were analyzed retrospectively to explore the causes of misdiagnosis as pulmonary infection.Part Ⅲ:Continue to analyze the medical records and prognosis of 80 patients with organizing pneumonia diagnosed and treated by the Department of Respiratory and Critical Care Medicine,and compare and analyze the influencing factors of recurrence and refractory of organizing pneumonia.Logistic regression analysis and nomogram analysis were performed on the data of recurrent patients to establish the prediction model of recurrence of organizing pneumonia.ResultIn the first part,38 surgical patients had mild clinical manifestations,most of which were lesions found in physical examination(45%),and 18% of patients had a small amount of hemoptysis or blood in sputum.The inflammatory indexes of some patients increased slightly,and the tumor markers increased in varying degrees in 50% of patients;The main radiology manifestations are nodule shadow,mass shadow and ground glass shadow.Other radiology signs include burr,lobulation,local pleural thickening,bronchial truncation,pleural traction depression,halo sign,air bronchial sign,etc.The pathology of mass shadow and nodule shadow tends to show the process of alveolar or alveolar lumen(such as fibrous tissue hyperplasia,polypoid granulation tissue,abscess,necrosis,etc.),while the pathology of ground glass shadow mainly shows the interstitial process(widening of alveolar septum,fibrosis and chronic inflammatory cell infiltration,etc.).In the second part,the main symptoms of 80 patients with medical puncture before admission were cough,expectoration(78%)and fever(43%),and only 6 patients(8%)were asymptomatic due to physical examination;Physical examination revealed 27 cases of wet rales and 3 cases of Velcro rales;CRP and ESR increased significantly in most patients during laboratory examination;Etiological examination revealed 7 cases of fungal infection,five cases of bacterial infection,three cases of tuberculosis,and 1 case of combined infection with fungi and tuberculosis.Chest CT showed that the lesions were patchy consolidation shadow,mass shadow,nodule shadow,ground glass shadow,strip shadow and other forms,with multiple large or patchy shadows(n=69,86.3%).Patchy consolidation shadow corresponds to typical pathological manifestations of OP(fibrous tissue in alveolar or alveolar duct,polypoid granulation tissue hyperplasia,etc.).In the third part,of the 80 patients with medical puncture,twenty recurred during the follow-up of more than half a year,and the recurrence rate was 25%.The recurrence group and non-recurrence group were compared,showing secondary organic pneumonia,time from symptom to visit,fever,COPD,bronchiectasis,neutrophils,AST γ-GT SCR,CT three quadrant area and oxygenation index had significant differences.Logistic regression analysis and nomogram analysis were carried out on the data of OP patients,and a prediction model for the refractory recurrence of OP was established.The time from symptom to visit,fever,neutrophil number and oxygenation index were the predictive factors of OP recurrence,among which oxygenation index was the most important index.ConclusionMost patients with isolated OP with mass,nodule or ground glass density shadow have no obvious symptoms.They are often found accidentally during physical examination.The infection index is often not obvious or only slightly increased,and half of them have increased tumor markers in varying degrees.Chest CT can be accompanied by suspicious malignant signs,so they are often misdiagnosed as malignant tumors at the initial diagnosis.Through in-depth analysis of the radiology,it can be judged to a certain extent,but on the premise that malignancy cannot be ruled out,surgical resection of the lesions can not only make a clear diagnosis,but also have therapeutic effect.It may be the first choice for the treatment of isolated OP.Most of the patients with massive and patchy solid changes have respiratory tract infection symptoms such as cough,expectoration and fever,and most of them are accompanied by the increase of CRP,ESR and other infection indexes in varying degrees.They are often misdiagnosed as pulmonary infection.The possibility of OP can be considered only after the poor effect of antibiotic treatment.By summarizing the characteristics of these patients,we can improve the puncture and obtain pathology as soon as possible,which is conducive to the early treatment of glucocorticoid.Long time from symptom to visit,fever,high number of neutrophils and low oxygenation index are independent risk factors for recurrence.For patients who predict the tendency of high recurrence rate,the use time of hormone can be appropriately prolonged and the reduction of hormone should be slower.