弥漫性泛细支气管炎24例临床分析

发布时间：2018-09-18 18:55

【摘要】：目的:通过探讨、总结弥漫性泛细支气管炎(Diffuse panbronchiolitis,DPB)的临床特点,以期提高临床医生对弥漫性泛细支气管炎的认识及诊断的准确性,改善患者预后。方法:回顾性分析2009年10月-2016年10月就诊于吉林大学中日联谊医院呼吸科的24例经临床诊断的弥漫性泛细支气管炎患者的临床资料。结果:24例患者中男性15例(62.5%),女性9例(37.5%),平均年龄58.04±13.58岁,病史2个月-35年,平均11.7年,主要症状和体征:慢性咳嗽(24/24,100%)、咳痰(24/24,100%)、劳力性呼吸困难(22/24,91.7%)、咯血或痰中带血(5/24,20.8%)、发热(9/24,37.5%)、发绀(7/24,29.2%)、湿Up音(24/24,100%)、杵状指(10/24,41.7%)、慢性副鼻窦炎或既往史(19/24,79.2%)、吸烟史(6/24,25.0%)。19例提检痰培养,11例为铜绿假单胞菌(11/19,57.89%)、2例肺炎克雷伯杆菌(2/19,10.53%)、2例流感嗜血杆菌(2/19,10.53%)、其余为正常菌群(4/19,21.05%);本组病例均行胸部CT检查,均可见双肺弥漫性分布小叶中心性颗粒状结节状高密度影,多见于双肺中下叶的肺野外带;18例患者行肺功能检查:第1秒用力呼气容积/用力肺活量(FEV1/FVC)、第1秒用力呼气容积占预计值百分比(FEV1%pred)分别为55.20±7.71%、56.49±7.996%。22例行动脉血气分析出现低氧血症,氧分压(Pa O2)、二氧化碳分压(Pa CO2)分别为60.64±8.27mm Hg、47.85±6.25mm Hg;4例患者行纤维支气管镜肺活检示细支气管及其周围组织可见淋巴细胞、浆细胞浸润。本组病例中13例有描述明确诊断为弥漫性泛细支气管炎前曾被误诊为慢性支气管炎(6/13,46.1%)、支气管扩张症(4/13,30.8%)、支气管哮喘(2/13,15.4%)、粟粒型肺结核(1/13,7.7%);24例患者经确诊后治疗上均应用十四或十五元环大环内酯类抗生素,其中红霉素10例,阿奇霉素9例,罗红霉素5例,经治疗后咳嗽、咳痰症状明显缓解,肺部Up音减少。结论:1、DPB发病率较低,近些年来,随着医学的发展、临床工作者的努力,我国关于DPB病例报道陆续出现;2、DPB临床表现不特异,误诊、漏诊率较高,需掌握DPB的临床特点,结合相关辅助检查,提高诊断的准确性;3、小剂量、长疗程十四、十五元环大环内酯类抗生素治疗可改善患者预后。
[Abstract]:Objective: to summarize the clinical features of diffuse panbronchiolitis (Diffuse panbronchiolitis,DPB) in order to improve the clinical understanding and diagnostic accuracy of diffuse panbronchiolitis and improve the prognosis of the patients. Methods: the clinical data of 24 patients with diffuse panbronchiolitis who were admitted to the Department of Respiratory, Sino-Japanese Friendship Hospital of Jilin University from October 2009 to October 2016 were retrospectively analyzed. Results there were 15 males (62.5%) and 9 females (37.5%) in the 24 patients with a mean age of 58.04 卤13.58 years, with a history of 2 months to 35 years (mean 11.7 years). Main symptoms and signs: chronic cough (24 / 24100%), expectoration (24 / 24100%), exertional dyspnea (22 / 242491.7%), hemoptysis or blood in phlegm (5 / 2420.8%), fever (9 / 242437.5%), cyanosis (7 / 2429.2%), wet Up tone (24 / 24100%), clubbing finger (10 / 24241.7%), chronic paranasal sinusitis or previous history (19r24249.2%), smoking history (6242425.0%). Pseudomonas aeruginosa (11 / 19 / 57.89%) and two cases of Klebsiella pneumoniae (2 / 19, 10.53%) and Haemophilus influenzae (2 / 19, 10.53%), the rest were normal bacteria (4 / 19, 21. 05%). Diffuse lobule central granular nodular high-density shadows were seen in both lungs. Pulmonary function tests were performed in 18 patients with pulmonary tract in the middle and lower lobes of the lungs: forced expiratory volume / forced vital capacity (FEV1/FVC) in the first second, the percentage of forced expiratory volume to the predicted value in the first second (FEV1%pred) was 55.20 卤7.71 and 56.49 卤7.996.22 patients had hypoxemia in arterial blood gas analysis. The partial pressure of oxygen (Pa O 2) and partial pressure of carbon dioxide (Pa CO2) were 60.64 卤8.27mm Hg,47.85 卤6.25mm Hg;4, respectively. Lung biopsy of bronchioles and its surrounding tissues showed infiltration of lymphocytes and plasma cells. Of the 13 patients, 13 had been misdiagnosed as chronic bronchitis (6 / 1366.1%), bronchiectasis (40.8%), bronchial asthma (2 / 1315.4%), miliary pulmonary tuberculosis (1 / 137.7%) before diagnosis. Fourteen or fifteen ring macrolides antibiotics, There were 10 cases of erythromycin, 9 cases of azithromycin and 5 cases of roxithromycin. After treatment, the symptoms of cough, expectoration and lung Up were obviously relieved. Conclusion the incidence of DPB is relatively low. In recent years, with the development of medicine and the efforts of clinical workers, there are many clinical features of DPB in China, such as nonspecific clinical manifestation, misdiagnosis and high rate of missed diagnosis. It is necessary to master the clinical characteristics of DPB. Combined with related auxiliary examination, improve the accuracy of diagnosis, low dose, long course of 14, 15 yuan ring macrolide antibiotics treatment can improve the prognosis of patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.21

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