弥漫性泛细支气管炎72例临床分析  

Clinical analysis of 72 Chinese patients with diffuse panbronchiolitis.

作　　者：李惠萍[1] 范峰[1] 李霞[1] 余慧[1] 赵兰[1] 易祥华[2] 何国钧[1] 

机构地区：[1]同济大学附属上海市肺科医院呼吸科,上海200433 [2]同济大学附属上海市肺科医院病理科,上海200433

出　　处：《中国实用内科杂志》2009年第4期328-332,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金资助项目(30671996);上海市优秀学科带头人计划(08XD14034);上海市科委科研基金资助项目(064107050;044107050;044119637;0852nm05600;08411961000)

摘　　要：目的提高弥漫性泛细支气管炎(DPB)诊治水平。方法收集2001年7月至2007年5月同济大学附属上海市肺科医院收治DPB患者72例。主要检查包括:X线胸片、胸部CT、副鼻窦CT、肺组织活检、肺功能检查、动脉血气分析、冷凝集试验、人类白细胞抗原HLA-BW54、痰细菌培养和药物敏感试验等。主要给予大环类酯类抗生素、糖皮质激素、针对感染致病菌的抗生素、氧疗、对症、支持疗法等综合治疗措施。结果(1)按诊断标准,确诊51例,一般诊断6例,可疑诊断15例。(2)所有病例均有咳嗽;98.6%患者有咳痰;气促者占91.7%;超过55.6%患者肺部听诊有干啰音;而有湿啰音者占94.4%;伴有肺气肿者占41.7%。(3)有副鼻窦炎者占77.8%;23.6%病例有吸烟史。(4)继发支气管扩张者45.8%、伴有肺心病者9.7%;4例(5.5%)同时合并支气管哮喘;伴发高血压者5.6%,伴发类风湿性关节炎者2.8%,伴发胸腺增生者1例。(5)经过以大环内酯类抗生素为主的综合治疗,80%的患者咳嗽、咳痰、气促和肺部干啰音均在3 d内得以明显减轻;超过90%的病例治疗后10～40 d影像学明显改善;治疗后第一秒用力呼气容积占用力肺活量比值(FEV1/FVC%)较治疗前有所提高;动脉血氧分压和动脉血氧饱和度均较治疗前提高。72例患者13例(18.1%)完全治愈,但停药后复发2例(15.38%),再次治疗后1例治愈,另1例好转;其余57例不同程度好转,好转者中2例在随访中死亡,1例死于糖尿病酮症酸中毒,另1例死于心肌梗死。(6)合并细菌感染以铜绿假单胞菌最多(29/70,41.4%);其次为副流感嗜血杆菌(8/70,11.4%),第三位是肺炎克雷白杆菌(4/70,5.7%)。(7)肺活检率9.7%;冷凝集试验阳性率14.3%(10/70);12例测定人类白细胞抗原HLA-BW54,仅3例阳性(25.0%)。(8)51.4%的患者被误诊为支气管扩张症,38.9%的患者最初被误诊为慢性支气管炎,其余依次为肺结核20.8%,特发性肺纤维化12.5%,支气管炎9.7%,结节病和哮�Objective The data of subjects with diffuse panbronchiolitis（DPB） who once administrated in our department were regressively analyzed and hope to help Chinese clinician to recognize them more clearly. Methods 72 patients who administrated in Shanghai Pulmonary Hospital from July of 2001 to April of 2007 and fulfilled the diagnostic criteria for DPB were assessed retrospectively for their clinical, radiological, arterial gas analysis, lung function, microbiological, response of the therapy, prognosis and other characteristics. The management was a comprehensive therapies that maerolides was the major ingredient. Results （ 1 ） All subjects presented with chronic cough and 98. 6% with copious purulent sputum production;66 cases （91.7% ）had dyspnea on exertion. 40 cases （55.6%）had wheezes and 68 （94. 4% ）had end inspiratory crackles in their chest at initial presentation. （2）30 cases （41.7% ） had emphysema, 56 cases （77. 8% ） had chronic sinusitis, 17 cases （ 23.6% ） were smoker, 33 cases （45.8%） had bronchoectasis and 7 cases （9.7%）with cor pulmonale,4 cases（5.5% ）had asthma at same time and only one patient had DPB family history. （ 3 ） Only 10 cases （ 14. 3% ） had elevated cold haemagglutinin titers and 7 cases （ 9. 7% ） had lung biopsy specimens. 3 of 12 cases （ 25.0% ） had positive expression of human leukocyte antigen-B54 （HLA-B54）. 29 cases （41.4%） had positive sputum pseudomonas aeruginosa. （4） 37 cases（51.4% ）were misdiagnosed as bronchoectasis and 28 cases（ 38.9% ）patients were misdiagnosed as chronic bronchitis initially. Almost all of them experienced a long time to make their diagnosis clear,the median span is 8-years. （5） 13 cases （ 18. 1% ） patients recovered entirely after therapy, but 2 of them relapsed after stop treatment and improved when started therapy again ;57 cases got improvement,2 of them died from other diseases during following up. Conclusion Our data suggested that there are actually some DPB pat

关 键 词：弥漫性泛细支气管炎 胸部C检查 肺组织活检 

分 类 号：R5[医药卫生—内科学]