3例急性纤维素性机化性肺炎的临床特点分析并文献复习

Analysis of the Clinical Features of 3 Cases of Acute Fibrinous and Organizing Pneumonia and Literature Review

摘要: 目的：总结急性纤维素性机化性肺炎(AFOP)的临床、影像、病理特征、诊疗策略与预后影响因素。方法：回顾本院经皮肺穿刺活检确诊的3例AFOP病例的临床资料、影像学与治疗结局；并检索2015~2025年国内外文献，合并获得AFOP病例共124例，提取人口学、症状体征、取材方式、治疗与结局等信息；以“死亡/恶化”为结局，纳入年龄分层、性别与是否机械通气等变量行多因素逻辑回归。结果：本组3例(女1例，男2例；79岁/49岁/60岁)均行经皮肺活检确诊，抗感染联合糖皮质激素治疗后症状与影像明显改善出院。文献汇总显示：女性66例(53.2%)，男性58例(46.8%)，年龄3~84岁；常见症状为咳嗽87例(70.2%)、发热80例(64.5%)、呼吸困难66例(53.2%)；诊断取材以经皮穿刺(54例)与经支气管镜活检(31例)为主；总体死亡23例(18.5%)。回归分析提示：机械通气是独立危险因素(OR = 9.37, 95%CI: 3.52~26.32, P < 0.001)；与青年及以下相比，中年患者预后较好(OR = 0.24, 95%CI: 0.05~0.93, P = 0.042)。结论：AFOP临床与影像缺乏特异性，抗感染无效的“难治性肺炎”应尽早获取组织学证据；糖皮质激素为当前主要治疗，需个体化起始与递减；一旦需机械通气提示高危，应强化监测与干预。

Abstract: Objective: To summarize the clinical, imaging, and pathological characteristics, diagnosis and treatment strategies, and prognostic influencing factors of acute fibrinous and organizing pneumonia (AFOP). Methods: We retrospectively reviewed three AFOP cases diagnosed at our hospital by percutaneous lung biopsy, documenting clinical data, imaging, and treatment outcomes. In addition, we searched the literature from 2015~2025 and pooled a total of 124 reported AFOP cases. Demographics, symptoms/signs, sampling methods, treatments, and outcomes were extracted. Using a composite endpoint of death or clinical deterioration, we performed multivariable logistic regression including age strata, sex, and use of mechanical ventilation. Results: In this group, all three patients (one female and two males; aged 79, 49, and 60 years) were diagnosed via percutaneous lung biopsy. After treatment with anti-infective therapy combined with glucocorticoids, both their symptoms and imaging findings showed marked improvement, and they were subsequently discharged. A review of the literature indicated that among the reported cases, 66 were female (53.2%) and 58 were male (46.8%), with ages ranging from 3 to 84 years. The most common symptoms included cough in 87 cases (70.2%), fever in 80 cases (64.5%), and dyspnea in 66 cases (53.2%). Diagnostic sampling was primarily performed by percutaneous puncture (54 cases) and transbronchoscopic biopsy (31 cases). Overall, 23 patients (18.5%) died. Regression analysis identified mechanical ventilation as an independent risk factor (OR = 9.37, 95% CI: 3.52~26.32, P < 0.001). In addition, middle-aged patients were associated with better prognosis compared to youth and younger patients (OR = 0.24, 95% CI: 0.05~0.93, P = 0.042). Conclusions: AFOP has no pathognomonic clinical or radiologic features; in antibiotic-refractory “pneumonia”, histopathologic confirmation should be obtained early. Systemic glucocorticoids remain the mainstay and require individualized initiation and tapering. The need for mechanical ventilation marks high risk and should trigger intensified monitoring and proactive intervention.