北京协和医院35例弥漫性泛细支气管炎住院患者临床特征分析  

Clinical Analysis of 35 Inpatients with Diffuse Panbronchiolitis in Peking Union Medical College Hospital

作　　者：娄丽丽[1] 巩海红[1] 张明强[1] 高金明[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸内科,北京100730

出　　处：《中国医学科学院学报》2015年第6期724-729,共6页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(81170040;81470229);国家科技支撑计划(2012BAI05B00)~~

摘　　要：目的总结弥漫性泛细支气管炎（DPB）患者的临床特征,增强对DPB的临床特点认识,以期早期诊断和及时治疗。方法回顾性分析1996年12月至2014年7月在北京协和医院住院确诊的35例DPB患者的临床资料,DPB诊断符合日本厚生省1998年第2次修订的DPB临床诊断标准或组织病理学标准。结果 35例DPB患者中,男性20例（57.1%）、女性15例（42.9%）,男女比例为1.33∶1;平均年龄（42.2±15.6）岁,主要分布在40~49岁;平均病史（8.4±8.5）年。35例（100%）均出现慢性咳嗽,31例（88.6%）有较多脓痰,24例（68.6%）出现劳力性呼吸困难,28例（80.0%）肺部可闻及吸气末爆裂音,26例（74.3%）有鼻窦炎病史,15例检测血凝集素实验者均为阴性,22例（73.3%）痰培养中可见铜绿假单胞菌、流感嗜血杆菌等G-细菌,26例（83.9%）血气分析出现低氧血症,患者的第1秒末用力呼气量/用力肺活量、残气量/肺总量、50%肺活量时最大用力呼气流量、25%肺活量时最大用力呼气流量的均值分别为60.5%、53.8%、25.9%、31.2%,胸部CT主要表现为肺部弥漫性小叶中心性微结节和支气管扩张,29例（82.9%）曾被误诊为肺部感染、支气管扩张等疾病。结论国内的DPB与日本有不一样的特征：血凝集素实验多为阴性,且痰病原体构成谱不一致。DPB常被误诊,对于反复出现肺部感染且合并鼻窦炎的患者,应高度警惕DPB。Objective To summarize the clinical features of diffuse panbronchiolitis（ DPB）. Method We retrospectively analyzed the clinical data of 35 patients who had been admitted to Peking Union Medical College Hospital from December 1996 to July 2014 due to DPB,which was confirmed basing on the diagnostic criteria proposed in 1998 by a working group of the Ministry of Health and Welfare of Japan or histopathological examination. Results The average age of these 35 patients（ 20 men and 15 women,with a sex ratio of 1. 33 to1） was（ 42. 2 ± 15. 6） years,mainly distributed in the 40-49 age group. The average clinical history was（ 8. 4 ±8. 5） years. The main symptoms and signs of DPB included chronic cough（ n = 35,100%）,copious purulent sputum production（ n = 31,88. 6%）,exertional dyspnoea（ n = 24,68. 6%）,end-inspiratory crackles（ n =28,80. 0%）. Also,26 patients（ 74. 3%） had a history of sinusitis. Cold agglutination test in 15 out of 15 patients were negative. Pseudomonas aeruginosa and Haemophilus influenza were isolated from 22 patients（ 73. 3%,22 /30）,and 26 patients（ 83. 9%,26 /31） had hypoxemia. The mean values of forced expiratory volume in the first second / forced vital capacity,residua volume / total lung volume,maximum forced expiratory volume of 50% lung volume, and maximum forced expiratory volume of 25% lung volume were 60. 5%,53. 8%,25. 9%,and 31. 2%,respectively. The most common CT findings from this cohort of patients were bronchiectasis and bronchiolitis,with nodular shadows distributed in a centrilobular pattern. Finally,29 patients were misdiagnosed as other conditions such as pulmonary infection and bronchiectasis. Conclusions DPB in Chinese populations have different presentations compared to that Japanese populations： for instance,the serum cold agglutination test always shows negative results,which is often inconsistent with the pathogens in sputum.DPB usually is misdiagnosed. Clinicians should take DPB into consideration when patients had pulmonary infect

关 键 词：弥漫性泛细支气管炎 临床特征 肺功能 

分 类 号：R562.11[医药卫生—呼吸系统]