弥漫性泛细支气管炎的临床特征  

Clinical characteristics of diffuse panbronchiolitis

作　　者：秦艳玲 姜晓红[1] 孙起翔 姚意恩 李超乾[1] QIN Yan-ling;JIANG Xiao-hong;SUN Qi-xiang;YAO Yi-en;LI Chao-qian(Department of Respiratory Medicine,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院呼吸内科,南宁市530021

出　　处：《广西医学》2021年第18期2149-2153,共5页Guangxi Medical Journal

基　　金：国家自然科学基金面上项目(81470230)。

摘　　要：目的总结弥漫性泛细支气管炎(DPB)的临床特点,为临床早诊断、早治疗DPB提供参考。方法回顾性分析40例确诊为DPB的患者的临床资料,总结患者的一般特征、临床表现、辅助检查特点、诊治及转归情况。结果(1)40例DPB患者年龄(53.8±16.3)岁,男女比例为0.54∶1,病史(8.1±8.4)年。(2)所有患者均存在咳嗽、咳痰,82.5%(33/40)的患者合并活动后气促,90.0%(36/40)的患者肺部可闻及湿性啰音。(3)35.0%(14/40)的患者白细胞计数升高,75.0%(30/40)的患者C反应蛋白水平升高。34例行痰培养的患者中,仅9例(26.5%)痰培养阳性,铜绿假单胞菌检出率仅为11.8%(4/34)。仅19例患者进行了血冷凝集素试验,其中2例效价增高。(4)39例行肺功能检测的患者中,38例存在气流受限合并严重的小气道功能障碍,包括17例阻塞性通气功能障碍、21例混合性通气功能障碍。40例患者均存在低氧血症。(5)胸部CT主要表现为弥漫性结节状、斑片状或粟粒样病变,可伴有支气管扩张或"树芽征"。38例患者鼻窦CT提示鼻窦炎。(6)在早期诊治时40例患者均被误诊为其他疾病,包括肺结核、慢性阻塞性肺疾病、肺部感染、支气管哮喘等。(7)39例患者在确诊后均接受大环内酯类药物治疗,最终37例好转,2例未愈。结论DPB的临床症状不典型,易误诊、漏诊,对于有咳嗽、咳痰、进行性劳力性呼吸困难、慢性鼻窦炎病史的患者尽早完善相关检查以早期明确诊断DPB。相较于传统的肺通气指标,小气道功能检测或更有助于早期诊断DPB,而明确诊断后尽早给予大环内酯类药物治疗可使患者获得较好的效果。Objective To summarize the clinical characteristics of diffuse panbronchiolitis(DPB)so as to provide the references for early diagnosis and treatment of DPB clinically.Methods The clinical data of 40 patients identified with DPB were retrospectively analyzed.The general features,clinical manifestations,signatures of auxiliary examination,diagnoses and treatments,and outcomes of the patients were summarized.Results(1)Forty DPB patients were 53.8±16.3 years old,had a male-to-female ratio of 0.54:1 and a length of medical history of 8.1±8.4 years.(2)All patients had cough and expectoration,wherein 82.5%(33/40)of the patients had concomitant shortness of breath after exercise and 90.0%(36/40)had pulmonary moist rales.(3)About 35.0%(14/40)of the patients experienced elevated WBC count,75%(30/40)experienced elevated C-reactive protein level.Among 34 cases undergoing sputum culture,only nine(26.5%)cases were tested positive for sputum culture,and the detection rate of Pseudomonas aeruginosa was only 11.8%(4/34).Only 19 cases undertook serum cold agglutinin test,including two cases of increased titer.(4)Among 39 cases undergoing lung function test,38 cases suffered from airflow limitation complicated with severe small airway dysfunction,including 17 cases of obstructive ventilatory disorder and 21 cases of mixed ventilatory disorder.All of the 40 cases had hypoxemia.(5)The disease was commonly presented as diffused nodular,patchy,or miliary lesions with bronchiectasis or"tree-in-bud sign"on chest CT.Nasal sinus CT indicated sinusitis in 38 cases.(6)Forty patients were misdiagnosed as pulmonary tuberculosis,chronic obstructive pulmonary disease,pulmonary infection,bronchial asthma,and other diseases in the early diagnosis and treatment.(7)Thirty-nine patients received macrolides therapy after definite diagnosis,among whom there were 37 improved and two uncured cases eventually.Conclusion DPB has atypical clinical symptoms and is prone to misdiagnosis and missed diagnosis.Perfecting the related examinations as soon as po

关 键 词：弥漫性泛细支气管炎 临床表现 肺功能 误诊 漏诊 治疗 转归 

分 类 号：R562.21[医药卫生—呼吸系统]