摘要
目的探讨我国弥漫性泛细支气管炎(DPB)的临床特点及诊断方法。方法将经开胸或胸腔镜肺活检证实的9例DPB患者的临床特点与日本修订的临床诊断标准进行比较分析。结果本组9例中8例有持续性咳嗽、咳痰及劳力性呼吸困难,7例有慢性鼻窦炎,7例肺部可闻及湿啰音,1例肺部可闻及哮鸣音;所有患者胸部CT均可见小叶中心性结节影,4例第一秒用力呼气容积/用力肺活量比值<70%,5例动脉血氧分压(PaO2)<80mmHg(1mmHg=0.133kPa),1例冷凝集素滴度≥1∶64。4例符合临床确诊标准,3例符合一般诊断,2例不符。其中8例接受了经支气管镜肺活检,均未获得明确的病理诊断。结论多数根据临床诊断标准拟诊本病的患者可给予大环内酯类药物治疗。本病误诊率高的根本原因是对本病的临床特点、诊断标准不熟悉。经支气管镜肺活检对本病的诊断帮助不大,临床诊断困难者可行开胸或胸腔镜下肺活检。
Objective To investigate the clinical features and diagnostic procedures for diffuse panbronchiolitis in Chinese patients. Methods With literature review, the clinical features and diagnostic procedures of diffuseal panbronchiolitis in a series of 9 patients with histopathological confirmation were retrospectively described and discussed. Results Of the 9 cases, 8 had persistent cough, sputum production and exertion dyspnea, 7 had chronic sinusitis, 9 had centrilobular micronodules on chest CT, 7 had coarse crackles, 4 had FEV1/FVC 〈 70%, 5 had PaO2 〈 80 mm Hg and 1 had titer of cold hemagglutinin ≥ 1：64. According to the Japanese revised clinical diagnostic criteria for diffuse panbronchiolitis, definite diagnosis could be made in 4 cases, probable in 3 and excluded in 2 cases, respectively, but it was clinically diagnosed or suspected only in 2 cases before clinicopathological confirmation, the remaining 7 cases were missed or mistaken for other diseases. Of the 9 cases, 8 had received transbronchial biopsy and all showed non-specific inflammation, which was in agreement with but nondiagnostic for diffuse panbronchiolitis. Conclusions Most cases of diffuse panbronchiolitis can be clinically diagnosed or suggested according to the clinical diagnostic criteria, proposed solely by Japanese experts which should be further validated in non-Japanese populations, ff difficulty in diagnosis arises, the diagnosis of diffuse panbronchiolitis should be based on its clinicopathological features and exclusion of other mimicking diseases. Of note, few cases can be confirmed by transbronchial biopsy, and in this case, surgical lung biopsy should be considered.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2005年第8期516-519,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
