弥漫性泛细支气管炎12例临床分析

Clinical analysis of 12 diffuse panbronchiolitis patients

目的探讨弥漫性泛细支气管炎(DPB)的临床及影像学特征。方法回顾分析我院2006～2010年确诊的12例DPB患者的临床及影像学资料,对该组患者进行随访,观察治疗前后临床症状、血气分析、影像学、肺功能的改善。结果入组患者12例,确定诊断9例,一般诊断3例。男7例,女5例。年龄42～73岁,平均(51±13)岁。从起病到确诊时间2个月～8年。随访时间(3.1±1.2)年。所有病例均有咳嗽、咳痰、活动后气促。X线胸片符合典型DPB改变7例,HRCT符合典型DPB改变12例,均可见小叶中性型结节,10例(83.33%)可见外周型支气管扩张,3例(25.00%)可见纵隔淋巴结肿大。12例患者影像学均有鼻窦炎表现。12例患者肺功能检查均表现为阻塞性通气功能障碍,其中6例(50.00%)伴有弥散性通气功能障碍。治疗后FEV1均恢复到80%以上。治疗前血气分析提示呼吸衰竭Ⅰ型2例(16.67%),呼吸衰竭Ⅱ型2例(16.67%),氧分压(未吸氧)低于80mmHg10例(83.33%)。治疗后呼吸衰竭均得到纠正。痰培养结果显示铜绿假单胞菌感染7例(58.3%),肺炎克雷伯杆菌2例(16.7%)。冷凝集试验:12例患者10例行冷凝集检查,2例阳性(20%)。12例患者中选用口服罗红霉素4例,口服阿奇霉素8例,平均服药时间(8±5)个月。治疗后咳嗽、咳痰及活动后气促症状均有不同程度改善。该组患者误诊为慢性支气管炎3例(25.0%),慢性阻塞性肺病2例(16.7%),支气管扩张5例(41.7%),肺结核1例(8.3%),间质性肺炎1例(8.3%)。结论①DPB临床误诊率较高;②加强对DPB的认识以及同其临床、影像、病理表现相似疾病的鉴别是诊断该病的关键;③中国人DPB患者冷凝集试验阳性率较低;④DPB对14及15元大环内酯类药物治疗有效。

Objective To investigate the clinical and imaging features of DPB.Methods Retrospectively analyzed 12 patients diagnosed DPB clinical and imaging data from 2006 to 2010,the patients were followed up to observe the changes of clinical symptoms,blood gas analysis,imaging,pulmonary function improved.Results 12 patients enrolled,9 patients were diagnosised clearly and 3 patients were generally diagnosed.7 males and 5 females.Aged from 42 to 73 years,mean 51±13 years old.Diagnosis time from onset 2 months to 8 years.Follow-up time were 3.1±1.2 years.All patients had cough,sputum,shortness of breath after the event.X-ray changes consistent with a typical DPB 7 cases,HRCT consistent with the typical changes in 12 patients with DPB,neutral lobular nodules were seen in 10 cases（83.33%）,peripheral bronchiectasis can be seen in 3 cases（25.00%） had mediastinal lymph node swelling large.12 patients had sinus imaging performance.12 patients were pulmonary function tests showed obstructive ventilatory dysfunction,of which 6 cases（50.00%） with diffuse ventilation dysfunction.FEV1 after treatment,were restored to 80%.Before treatment,blood gas analysis revealed respiratory failure in 2 cases of type Ⅰ（16.67%）,respiratory failure,2 cases of type Ⅱ（16.67%）,partial pressure of oxygen（no oxygen） below 80mmHg 10 cases（83.33%）.Respiratory failure after treatment were corrected.Sputum culture results showed that Pseudomonas aeruginosa infection in 7 cases（58.3%）,Klebsiella pneumoniae in 2 cases（16.7%）.Agglutination：12 patients were 10 line agglutination examination,2 were positive（20%）.12 patients use oral roxithromycin in 4 cases,8 cases of oral azithromycin,the average time for medication 8±5 months.After treatment,cough,sputum and dyspnea on exertion symptoms were improved.This group of patients misdiagnosed as chronic bronchitis,3 cases（25.0%）,chronic obstructive pulmonary disease in 2 cases（16.7%）,bronchiectasis in 5 patients（41.7%）,tuberculosis in 1 case（8.3%）,interstitial pneumonia（n=18.3%）.Conclusion DPB higher rate of clinical misdiagnosis.To strengthen the awareness of DPB as well as with the clinical,radiologic and pathologic findings similar to the disease,the differential diagnosis of the disease is the key.Chinese patients of DPB are relatively low positive rate of agglutination.14 and 15 macrolide drug treatment are effective to DPB.