弥漫性泛细支气管炎23例临床分析

Clinical analysis of twenty three patients with diffuse panbronchiolifis.

目的探讨我国弥漫性泛细支气管炎（DPB）患者的临床特点，以提高临床医师对此病的认识。方法回顾分析我院诊治的23例DPB患者的临床资料，并与日本DPB的临床特点进行对比分析。结果①男女比例为1：1．3，发病平均年龄46岁，73．9％无吸烟史。初诊常见为慢性支气管炎8例（34．8％），支气管扩张5例（21．7％），肺间质纤维化5例（21．7％），肺部感染4例（17．4％），恶性肿瘤1例（4．34％）。无一例初诊确诊。②86．9％合并或既往有慢性鼻窦炎。③全部病例均有咳嗽症状，95．7％咳痰，78．3％活动后呼吸困难。肺部听诊82．6％可闻及湿哆音。④82．6％冷凝集试验阴性，86．9％Pa02〈80mMHg，部分患者ESR、CRP、IgG、IgA升高，类风湿因子阳性。13例行人类白细胞抗原（HLA）-Ⅰ类抗原检测，B54阳性2例，B7阳性5例，A11阳性5例。⑤肺功能检查，65．2％为混合性通气功能障碍，69．6％弥散功能减低。⑥痰培养阳性率为65．2％，多为革兰阴性杆菌，最常见为铜绿假单胞菌。⑦60．8％X线胸片可见弥漫性小结节影，全部病例胸部高分辨cT可见弥漫性小叶中心性小结节。⑧经支气管镜肺活检阳性率20％。结论DPB发病与性别、年龄、是否吸烟无明显关系，慢性鼻窦炎是诊断DPB的重要线索，目前我国对该病的认识不足，初诊确诊率极低；我国DPB患者有自身的特点，肺通气功能检查多为混合性通气功能障碍，弥散功能减低，可能与病史长、治疗不及时、病情进展有关；冷凝集试验阳性率低，这一指标可能不适于日本人之外的其他人种。

Objective To investigate the clinical features of diffuse panbronchiolitis （DPB） in Chinese population in order to improve the clinicians＇ cognitive level. Methods The clinical features of 23 patients with DPB were retrospectively analyzed on clinical features of Japan DPB. Results （1）The ratio of male to female was 1 ： 1.3. Average age of onset was 46 years old. 73.9% of the cases were non-smokers. First diagnosis could be chronic bronchitis （34.8 % ）, bronchiectasis （21.7 % ）, pulmonary interstitial fibrosis （21.7 % ）, pulmonary infection （17.4%） and malignant tumor（4.34% ）. None was considered as DPB. （2）86.9% of DPB patients were suffering from chronic sinusitis or with a history. （3）All presented with chronic cough. Productive cough occurred in 95.7% of the cases and exertional dyspnea in 78.3%. Moist rale could be heard in 82.6%. （4）The results of cold hemaggluti- nin test（CHA） were negative in 82.6%. Artery partial pressure of oxygen （PaO2 ）was less than 80 mm Hg in 86.9%. Erythrocyte sedimentation rate （ ESR）, C-reactive protein （ CRP ） and immunoglobulin G, A （ IgG, IgA） were elevated and rheumatoid factor （RF） was positive in some cases. 13 patients accepted human leukocyte antigens（HLA） class Ⅰ antigens test. 2 had B54 antigen,5 had B7 antigen,5 had All antigen. （5）In pulmonary function test, mixed ventilation dysfunction occurred in 65.2% and diffusion function decreased in 69.6%. （6）Microorganisms were cultured in 65.2% of patient＇s sputum and most was Pseudomonas aeruginosa. （7）In chest X-ray diffuse small nodules could be seen in 60.8% and diffuse centrilobular nodules in high resolution computed tomography（HRCT） in all patients. （8）The positive rate of transbronchoscopic lung biopsy（TBLB） was 20%. Conclusion These factors including sex, age and smoking history play little role in DPB. Chronic sinusitis is a considerable clue for diagnosis of DPB. At present, underdiagnosis is prevail as a resuh of unfamiliarity with DPB in China. DPB in Chinese. has its own clinical features. More mixed ventilation dysfunction and diffusion function decrease can be observed. Maybe it＇s the fault of long history, insufficient treatment and advancement of the disease. The fact that most patients are negative to the cold hemagglutinin test suggests that this index might not be applicable to non- Japanese patients.