弥漫性泛细支气管炎误诊4例临床分析

Clinical Analysis of Diffuse Panbronchiolitis in 4 Patients

[目的]探讨弥漫性泛细支气管炎的临床特征诊断及治疗方法。[方法]分析4例弥漫性泛细支气管炎患者临床表现、实验室检查、影像学、肺功能特点以及治疗效果。[结果]弥漫性小叶中心性结节3例,两肺弥漫性小叶中心性颗粒样结节状阴影合并广泛支气管扩张1例。4例患者鼻窦CT均提示副鼻窦炎,2例合并鼻息肉。肺功能检查3例患者呈阻塞性通气功能障碍,1例呈混合性通气功能障碍;4例FEV1/FVC(一秒钟用力呼气容积/用力肺活量)均<70%。4例经过大环内酯类药物3～6个月后均取得较好的疗效。[结论]弥漫性泛细支气管炎可根据病史、临床表现、影像学及肺组织活检进行诊断,及时使用红霉素等大环内酯类药物治疗则可以阻止病变进展,改善预后。

[Objective]To approach the clinical feature,diagnosis and treatment of diffuse panbronchiolitis.[Method]We reported the diffuse panbronchiolitis(DPB)in 4 patients and analysed the clinical manifestations,related lab test result,pulmonany function,imaging manifestations and treatment effects.[Result]Pulmonary high resolution computed tomography showed diffuse nodular pattern in three cases,and bronchiectasis in another case;Nasal cavity CT of all four patients showed accessory sinusitis,and two of these had nasal polyp at the same time;The pulmonary function tests showed an obstructive ventilation function disturbance in three cases,and mixed ventilatory dysfunction in the other one;FEV1/FVC<70% in all cases.Four patients were treated with drug of macrolides for 3 to 6 months,all of them acquired good therapeutic effect.[Conclusion]We can diagnose DPB based on clinical manifestations,imaging manifestations and lung biopsy.The earlier diagnosis,the faster treatment can be given with drug of macrolides.In this way,the prognosis of the DPB patients can be meliorated.