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

发布时间：2018-08-15 11:53

【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。
[Abstract]:Objective to summarize the clinical features of patients with diffuse panbronchiolitis (DPB) and to enhance the understanding of the clinical features of DPB in order to diagnose and treat in time. Methods the clinical data of 35 DPB patients who were hospitalized in Peking Union Hospital from December 1996 to July 2014 were analyzed retrospectively. The diagnosis of dpb was in accordance with the second revised DPB clinical diagnostic criteria or histopathological criteria of Japan's Ministry of Health and Health in 1998. Results among the 35 DPB patients, 20 were male (57.1%), 15 were female (42.9%), the ratio of male to female was 1.33: 1, the average age was (42.2 卤15.6) years old, mainly distributed in 400-49 years old. The mean history was (8.4 卤8.5) years. 35 cases (100%) had chronic cough. 31 cases (88.6%) had chronic cough. 24 cases (68.6%) had more pus phlegm, 28 cases (80.0%) had laborious dyspnea, 26 cases (74.3%) had a history of nasal sinus disease and 26 cases (74.3%) had a history of nasal sinusitis, 28 cases (80.0%) had pulmonary dyspnea and 26 cases (74.3%) had a history of nasosinusitis. Pseudomonas aeruginosa was found in 22 cases (73.3%) of sputum culture. Haemophilus influenzae and other G-bacteria (83.9%) showed hypoxemia in blood gas analysis. Forced expiratory volume / forced vital capacity at the end of the first second was observed in 26 patients. The mean value of maximum forced expiratory flow at 50% vital capacity and 25% vital capacity was 60.5% 53.8% and 25.9%, respectively. The main CT manifestations were diffuse lobular central microtubercle and bronchiectasis in 29 cases (82.9%). Was misdiagnosed as a lung infection, Bronchiectasis, etc. Conclusion DPB in China is different from that in Japan: hemagglutinin test is negative and sputum pathogen composition spectrum is inconsistent. Dpb is often misdiagnosed. The patients with recurrent pulmonary infection and sinusitis should be on high alert.
【作者单位】：中国医学科学院北京协和医学院北京协和医院呼吸内科;
【基金】：国家自然科学基金(81170040,81470229) 国家科技支撑计划(2012BAI05B00)~~
【分类号】：R562.21

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