山西医科大学学报2017，Vol.48Issue(6)：571-574,4.DOI:10.13753/j.issn.1007-6611.2017.06.013
表现为间质性肺炎的肺腺癌15例临床分析
Clinical analysis of 15 cases of lung adenocarcinoma presenting as interstitial pneumonia
摘要
Abstract
Objective To improve the understanding of the clinical manifestation and radiologic imaging diversity of lung adenocarcinoma and reduce misdiagnosis.Methods Clinical and imaging data of 15 cases of lung adenocarcinoma presenting as interstitial pneumonia were retrospectively analyzed.The data were collected form Army General Hospital from July 2012 to May 2015.Results All the 15 cases (8 males and 7 females,aged 47-77 years old,mean 57.5 ± 8.2 years old) had the symptoms of cough,expectoration and dyspnea in varying degrees.Six cases of them had fever(37.8-38.8 ℃).Coarse crackles was heard in one or two lung fields of 13 patients.Blood tumor markers were elevated in 13 patients.Monoxide diffusion function was reduced in 15 patients.Blood gas analysis presented type Ⅰ respiratory failure in 14 patients.Chest computed tomography showed ground glass opacities,consolidation with air bronchograms,small nodules shadows and reticulation shadow in two lung fields.The patients all were treated with broad-spectrum antibiotics and the symptoms were not improved.Among 15 patients,12 patients with progressive dyspnea received corticosteroid therapy,and then the dyspnea of the patients was improved and the crackles of lung was reduced.Arterial oxygen partial pressure of the patients raised to 70-80 mmHg,but the pulmonary lesion of chest CT scan was not absorbed.The patients all were diagnosed as lung adenocarcinoma by percutaneous lung biopsy.Five patients refused chemotherapy and discharged.Three patients died after 2-3 months from the onset and two patients were lost for follow up.Eight patients received chemotherapy and survived for 8-10 months.Two patients with EGFR gene mutation were treated with chemotherapy combined with epidermal growth factor receptor inhibitor-gefitinib and still survived after three-year follow-up.Conclusion Clinical manifestation and imaging of lung adenocarcinoma are diverse and non-specific,and even some of them present as interstitial pneumonia.Clinicians must improve the understanding of the lung adenocarcinoma and obtain actively pathologic diagnosis by precutaneous lung biopsy.关键词
肺腺癌/间质性肺炎/胸部CTKey words
lung adenocarcinoma/interstitial pneumonia/chest CT scan分类
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李建东,郝淑玲,王斐..表现为间质性肺炎的肺腺癌15例临床分析[J].山西医科大学学报,2017,48(6):571-574,4.
