弥漫性泛细支气管炎2例临床分析并文献复习  

Clinical analysis of two patients with diffuse panbronchiolitis

作　　者：计军[1] 刘京京[1] 段艳红[1] 肖建[1] 周锋[1] 周磊[1] 吴波[1] 吴超民[1] 

机构地区：[1]复旦大学附属中山医院青浦分院呼吸内科,上海201700

出　　处：《国际呼吸杂志》2012年第22期1703-1708,共6页International Journal of Respiration

基　　金：上海市卫生局青年发展基金（20LOY045）;上海市青浦区科委科技发展基金（青科发2011-18）

摘　　要：目的探讨弥漫性泛细支气管炎（DPB）的临床特点及治疗。方法回顾性分析我院2例确诊为DPB患者的临床特点及治疗，并复习相关文献。结果2例均以慢性咳嗽、咳痰伴活动后气促为主诉，肺部听诊均闻及湿哕音，HLAB54均阳性，但冷凝集试验均阴性，肺功能均以阻塞性通气功能障碍为主；1例经病理确诊，胸部影像见典型弥漫小叶中心性结节影，但无慢性鼻窦炎病史，口服阿奇霉素0．25g，隔日1次，治疗12个月后肺部病灶明显吸收；1例经临床确诊，胸部影像见典型弥漫结节影伴支气管扩张和间质性肺纤维化，既往有慢性鼻窦炎病史，口服阿奇霉素0．25g，隔日1次，治疗7个月后肺部病灶明显吸收；2例患者初期均长期误诊。结论2例患者具有DPB典型临床表现，但某些特征有别于一般日本DPB患者，2例病例均显示长期口服小剂量阿奇霉素治疗DPB效果显著。Objective To recognize the clinical characteristics and therapy for diffuse panbronchiolitis （DPB） more clearly. Methods Two patients with DPB who once administrated in our department were retrospectively analyzed and literatures were reviewed. Results Both of them suffered from persistent cough, sputum, and exertional dyspnea, and auscultation revealed coarse crackles, and the detection of HLA-B54 was positive, but the titre of cold haemagglutinin was negative,and pulmonary function tests of them showed a significant airflow limitation. One patient who was diagnosed by thoracoscopic lung biopsy, characterised with bilateral diffuse small nodular shadows on a plain chest radiography film and centrilobular micronodules on chest computed tomography images and without a history of chronic paranasal sinusitis, and then recovered after 0.25 g azithromycin administered every other day for 12 months. The other who was definitely established by diagnostic criteria for DPB, characterised with bilateral, diffuse, small nodular shadows, bronchiectasis and interstitial pulmonary fibrosis on chest computed tomography images and also without a history of chronic paranasal sinusitis, and then recovered after 0.25 g azithromycin administered every other day for 7 months. The image typing of two patients was no significant correlation with the clinical severity, and both of them were initially long-term misdiagnosed. Conclusions This group of patients had showed the typical clinical manifestations of DPB, but some characteristics are different from Japan patients,and it has showed long- term oral administration of small doses of azithromycin in the treatment of DPB is significantly effect.

关 键 词：弥漫性泛细支气管炎 临床特点 鉴别诊断 阿奇霉素 

分 类 号：R562.21[医药卫生—呼吸系统]