当密度大于空气的物质（例如脓液、水肿、血液、表面物质、蛋白或细胞等）存在于肺实质内时，就会出现持续的肺部浸润影。无好转或缓慢好转的肺炎是持续性肺部浸润最常见的广义分类。[1]Menendez R, Perpina M, Torres A. Evaluation of non-resolving and progressive pneumonia. Semin Respir Infect. 2003 Jun;18(2):103-11.http://www.ncbi.nlm.nih.gov/pubmed/12840791?tool=bestpractice.com[2]Kuru T, Lynch JP 3rd. Non-resolving or slowly resolving pneumonia. Clin Chest Med. 1999 Sep;20(3):623-51.http://www.ncbi.nlm.nih.gov/pubmed/10516909?tool=bestpractice.com[3]Cunha BA. Slowly resolving and nonresolving pneumonias. Drugs Today (Barc). 2000 Dec;36(12):829-34.http://www.ncbi.nlm.nih.gov/pubmed/12845341?tool=bestpractice.com 持续存在是由于宿主免疫缺陷机制、不常见或耐药性微生物的存在，或者罹患类似于肺炎改变的疾病。[4]Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 (Suppl 2):S27-72.https://academic.oup.com/cid/article/44/Supplement_2/S27/372079http://www.ncbi.nlm.nih.gov/pubmed/17278083?tool=bestpractice.com[5]Mittl RL Jr, Schwab RJ, Duchin JS, et al. Radiographic resolution of community-acquired pneumonia. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):630-5.http://www.ncbi.nlm.nih.gov/pubmed/8118630?tool=bestpractice.com[6]Orens JB, Sitrin RG, Lynch JP 3rd. The approach to nonresolving pneumonia. Med Clin North Am. 2004 Feb;52(2):224-9.http://www.ncbi.nlm.nih.gov/pubmed/8078373?tool=bestpractice.com
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分类
对这些疾病的分类可能很复杂，因为有些临床医师仅仅专注于影像学改变，另一些则强调所伴随的临床症状。 不吸收性或缓慢吸收性肺炎只是宽泛的定义为即使经过至少10日足量抗生素治疗，临床症状无好转甚至进一步进展的肺炎；或者是影像学上12周尚未吸收的浸润影。[7]El Solh AA, Aquilina AT, Gunen H, et al. Radiographic resolution of community-acquired bacterial pneumonia in the elderly. J Am Geriatr Soc. 2004 Feb;52(2):224-9.http://www.ncbi.nlm.nih.gov/pubmed/14728631?tool=bestpractice.com[8]Fein AM, Feinsilver SH, Niederman MS. Nonresolving or slowly resolving pneumonia: diagnosis and management in the elderly patient. Clin Chest Med. 1993 Sep;14(3):555-69.http://www.ncbi.nlm.nih.gov/pubmed/8222569?tool=bestpractice.com 延缓吸收性肺炎通常被定义为临床情况有所改善的患者影像学浸润影持续存在时间长于 4 周（1 月内消退<50%）。[9]Eisenberg GM, Flippin HF, Israel HL, et al. Delayed resolution of pneumonias. Med Clin North Am. 1956 Sep;40(5):1291-303.http://www.ncbi.nlm.nih.gov/pubmed/13358319?tool=bestpractice.com[10]Kirtland SH, Winterbauer RH. Slowly resolving, chronic, and recurrent pneumonia. Clin Chest Med. 1991 Jun;12(2):303-18.http://www.ncbi.nlm.nih.gov/pubmed/1855373?tool=bestpractice.com[11]Rome L, Murali G, Lippmann M. Nonresolving pneumonia and mimics of pneumonia. Med Clin North Am. 2001 Nov;85(6):1511-30, xi.http://www.ncbi.nlm.nih.gov/pubmed/11680114?tool=bestpractice.com[12]Fein AM, Feinsilver SH. Non-resolving and slowly resolving pneumonia. In: Feinsilver SH, Fein AM, eds. Textbook of bronchoscopy. Baltimore, MD: Williams & Wilkins; 1995:286-301.
对于患有非结核性细菌性肺炎的老年患者，缓慢吸收的肺炎建议观察12至14周后才将考虑为不吸收性（或慢性）肺炎。[7]El Solh AA, Aquilina AT, Gunen H, et al. Radiographic resolution of community-acquired bacterial pneumonia in the elderly. J Am Geriatr Soc. 2004 Feb;52(2):224-9.http://www.ncbi.nlm.nih.gov/pubmed/14728631?tool=bestpractice.com 无反应性肺炎是指对于抗生素治疗无明显临床效果。 它是死亡及肺部浸润影延迟消散的独立危险因素。[13]Menendez R, Torres A, Zalacaín R, et al. Neumofail Group. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax. 2004 Nov;59(11):960-5.http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1746855&blobtype=pdfhttp://www.ncbi.nlm.nih.gov/pubmed/15516472?tool=bestpractice.com[14]Menendez R, Torres A. Treatment failure in community-acquired pneumonia. Chest. 2007 Oct;132(4):1348-55.http://www.ncbi.nlm.nih.gov/pubmed/17934120?tool=bestpractice.com 约有 20% 的不吸收性肺炎病例是由非感染性病因引起的。[13]Menendez R, Torres A, Zalacaín R, et al. Neumofail Group. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax. 2004 Nov;59(11):960-5.http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1746855&blobtype=pdfhttp://www.ncbi.nlm.nih.gov/pubmed/15516472?tool=bestpractice.com
对于治疗的反应
肺部浸润影临床治疗反应良好被定义为4周的治疗可使肺部影像学上浸润影吸收50%。[7]El Solh AA, Aquilina AT, Gunen H, et al. Radiographic resolution of community-acquired bacterial pneumonia in the elderly. J Am Geriatr Soc. 2004 Feb;52(2):224-9.http://www.ncbi.nlm.nih.gov/pubmed/14728631?tool=bestpractice.com 即使肺部影像学异常仍持续存在，临床症状好转和高血象恢复支持抗生素治疗有效的结论。[4]Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 (Suppl 2):S27-72.https://academic.oup.com/cid/article/44/Supplement_2/S27/372079http://www.ncbi.nlm.nih.gov/pubmed/17278083?tool=bestpractice.com[14]Menendez R, Torres A. Treatment failure in community-acquired pneumonia. Chest. 2007 Oct;132(4):1348-55.http://www.ncbi.nlm.nih.gov/pubmed/17934120?tool=bestpractice.com 在肺炎的病例，大部分患者会在治疗后3-5天后体温下降、咳嗽减少。若临床症状并未好转且胸部影像学无变化甚至进展，或者4周的治疗后浸润影仍无部分消散，即使患者无症状，也必须进行进一步的评估。[2]Kuru T, Lynch JP 3rd. Non-resolving or slowly resolving pneumonia. Clin Chest Med. 1999 Sep;20(3):623-51.http://www.ncbi.nlm.nih.gov/pubmed/10516909?tool=bestpractice.com[11]Rome L, Murali G, Lippmann M. Nonresolving pneumonia and mimics of pneumonia. Med Clin North Am. 2001 Nov;85(6):1511-30, xi.http://www.ncbi.nlm.nih.gov/pubmed/11680114?tool=bestpractice.com[15]Woodhead M, Blasi F, Ewig S, et al; Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect. 2011 Nov;17 (Suppl 6):E1-59.https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/Woodhead_et_al_CMI_Sep_2011_LRTI_GL_fulltext.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/21951385?tool=bestpractice.com
不同的治疗反应
不吸收性肺炎的消散各不相同，主要取决于致病因素、病情严重程度以及宿主因素。[5]Mittl RL Jr, Schwab RJ, Duchin JS, et al. Radiographic resolution of community-acquired pneumonia. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):630-5.http://www.ncbi.nlm.nih.gov/pubmed/8118630?tool=bestpractice.com[7]El Solh AA, Aquilina AT, Gunen H, et al. Radiographic resolution of community-acquired bacterial pneumonia in the elderly. J Am Geriatr Soc. 2004 Feb;52(2):224-9.http://www.ncbi.nlm.nih.gov/pubmed/14728631?tool=bestpractice.com 某些危险因素会阻碍影像学吸收的速度：
年龄大于60岁：20岁以后，每增加10岁，抗生素治疗后影像学浸润影消散的速度会减慢20%。[2]Kuru T, Lynch JP 3rd. Non-resolving or slowly resolving pneumonia. Clin Chest Med. 1999 Sep;20(3):623-51.http://www.ncbi.nlm.nih.gov/pubmed/10516909?tool=bestpractice.com[16]Cassiere H, Rodrigues JC, Fein AM. Delayed resolution of pneumonia: when is slow healing too slow? Postgrad Med. 1996 Jan;99(1):151-4, 157-8.http://www.ncbi.nlm.nih.gov/pubmed/8539201?tool=bestpractice.com
营养不良
合并症（COPD、心力衰竭、糖尿病、肾衰竭、免疫缺陷、饮酒、吸烟、职业暴露、癌症、癌症治疗、系统性疾病）：患有血液系统恶性肿瘤、免疫抑制疾病的患者，或者暴露于硅、铝或钛尘的患者容易出现持续性肺部浸润
致病性微生物
感染的初始严重程度
治疗延迟
