中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2009年
1期
51-54
,共4页
弥漫性泛细支气管炎%肺功能%冷凝集试验%人类白细胞抗原
瀰漫性汎細支氣管炎%肺功能%冷凝集試驗%人類白細胞抗原
미만성범세지기관염%폐공능%냉응집시험%인류백세포항원
Diffuse panbronchiolitis%Pulmonary function%Cold hemagglutinin test%Human leukocyte antigens
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%PaO2＜80 mmHg,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.
目的 探討我國瀰漫性汎細支氣管炎(DPB)患者的臨床特點,以提高臨床醫師對此病的認識.方法 迴顧分析我院診治的23例DPB患者的臨床資料,併與日本DPB的臨床特點進行對比分析.結果 ①男女比例為1:1.3,髮病平均年齡46歲,73.9%無吸煙史.初診常見為慢性支氣管炎8例(34.8%),支氣管擴張5例(21.7%),肺間質纖維化5例(21.7%),肺部感染4例(17.4%),噁性腫瘤1例(4.34%).無一例初診確診.②86.9%閤併或既往有慢性鼻竇炎.③全部病例均有咳嗽癥狀,95.7%咳痰,78.3%活動後呼吸睏難.肺部聽診82.6%可聞及濕哆音.④82.6%冷凝集試驗陰性,86.9%PaO2＜80 mmHg,部分患者ESR、CRP、IgG、IgA升高,類風濕因子暘性.13例行人類白細胞抗原(HLA)-I類抗原檢測,B54暘性2例,B7暘性5例,A11暘性5例.⑤肺功能檢查,65.2%為混閤性通氣功能障礙,69.6%瀰散功能減低.⑥痰培養暘性率為65.2%,多為革蘭陰性桿菌,最常見為銅綠假單胞菌.⑦60.8%X線胸片可見瀰漫性小結節影,全部病例胸部高分辨CT可見瀰漫性小葉中心性小結節.⑧經支氣管鏡肺活檢暘性率20%.結論 DPB髮病與性彆、年齡、是否吸煙無明顯關繫,慢性鼻竇炎是診斷DPB的重要線索,目前我國對該病的認識不足,初診確診率極低;我國DPB患者有自身的特點,肺通氣功能檢查多為混閤性通氣功能障礙,瀰散功能減低,可能與病史長、治療不及時、病情進展有關;冷凝集試驗暘性率低,這一指標可能不適于日本人之外的其他人種.
목적 탐토아국미만성범세지기관염(DPB)환자적림상특점,이제고림상의사대차병적인식.방법 회고분석아원진치적23례DPB환자적림상자료,병여일본DPB적림상특점진행대비분석.결과 ①남녀비례위1:1.3,발병평균년령46세,73.9%무흡연사.초진상견위만성지기관염8례(34.8%),지기관확장5례(21.7%),폐간질섬유화5례(21.7%),폐부감염4례(17.4%),악성종류1례(4.34%).무일례초진학진.②86.9%합병혹기왕유만성비두염.③전부병례균유해수증상,95.7%해담,78.3%활동후호흡곤난.폐부은진82.6%가문급습치음.④82.6%냉응집시험음성,86.9%PaO2＜80 mmHg,부분환자ESR、CRP、IgG、IgA승고,류풍습인자양성.13례행인류백세포항원(HLA)-I류항원검측,B54양성2례,B7양성5례,A11양성5례.⑤폐공능검사,65.2%위혼합성통기공능장애,69.6%미산공능감저.⑥담배양양성솔위65.2%,다위혁란음성간균,최상견위동록가단포균.⑦60.8%X선흉편가견미만성소결절영,전부병례흉부고분변CT가견미만성소협중심성소결절.⑧경지기관경폐활검양성솔20%.결론 DPB발병여성별、년령、시부흡연무명현관계,만성비두염시진단DPB적중요선색,목전아국대해병적인식불족,초진학진솔겁저;아국DPB환자유자신적특점,폐통기공능검사다위혼합성통기공능장애,미산공능감저,가능여병사장、치료불급시、병정진전유관;냉응집시험양성솔저,저일지표가능불괄우일본인지외적기타인충.
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 ①The 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.②86.9% of DPB patients were suffering from chronic sinusitis or with a history.③All 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%.④The results of cold hemagglutinin 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 A11 antigen.⑤In pulmonary function test,mixed ventilation dysfunction occurred in 65.2%and diffusion function decreased in 69.6%.⑥Microorganisms were cultured in 65.2%of patient's sputum and most wag Pseudomonas aeruginosa.⑦In chest X-ray diffuse small nodules could be seen in 60.8%and diffuse centrilobulal nodules in high resolution computed tomography(HRCT)in all patients.⑧The 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 result 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 ale negative to the cold hemagglutinin test suggests that this index might not be applicable to non-Japanese patients.
