【摘要】：目的:通過探討、總結(jié)彌漫性泛細(xì)支氣管炎(Diffuse panbronchiolitis,DPB)的臨床特點(diǎn),以期提高臨床醫(yī)生對彌漫性泛細(xì)支氣管炎的認(rèn)識及診斷的準(zhǔn)確性,改善患者預(yù)后。方法:回顧性分析2009年10月-2016年10月就診于吉林大學(xué)中日聯(lián)誼醫(yī)院呼吸科的24例經(jīng)臨床診斷的彌漫性泛細(xì)支氣管炎患者的臨床資料。結(jié)果:24例患者中男性15例(62.5%),女性9例(37.5%),平均年齡58.04±13.58歲,病史2個月-35年,平均11.7年,主要癥狀和體征:慢性咳嗽(24/24,100%)、咳痰(24/24,100%)、勞力性呼吸困難(22/24,91.7%)、咯血或痰中帶血(5/24,20.8%)、發(fā)熱(9/24,37.5%)、發(fā)紺(7/24,29.2%)、濕Up音(24/24,100%)、杵狀指(10/24,41.7%)、慢性副鼻竇炎或既往史(19/24,79.2%)、吸煙史(6/24,25.0%)。19例提檢痰培養(yǎng),11例為銅綠假單胞菌(11/19,57.89%)、2例肺炎克雷伯桿菌(2/19,10.53%)、2例流感嗜血桿菌(2/19,10.53%)、其余為正常菌群(4/19,21.05%);本組病例均行胸部CT檢查,均可見雙肺彌漫性分布小葉中心性顆粒狀結(jié)節(jié)狀高密度影,多見于雙肺中下葉的肺野外帶;18例患者行肺功能檢查:第1秒用力呼氣容積/用力肺活量(FEV1/FVC)、第1秒用力呼氣容積占預(yù)計值百分比(FEV1%pred)分別為55.20±7.71%、56.49±7.996%。22例行動脈血?dú)夥治龀霈F(xiàn)低氧血癥,氧分壓(Pa O2)、二氧化碳分壓(Pa CO2)分別為60.64±8.27mm Hg、47.85±6.25mm Hg;4例患者行纖維支氣管鏡肺活檢示細(xì)支氣管及其周圍組織可見淋巴細(xì)胞、漿細(xì)胞浸潤。本組病例中13例有描述明確診斷為彌漫性泛細(xì)支氣管炎前曾被誤診為慢性支氣管炎(6/13,46.1%)、支氣管擴(kuò)張癥(4/13,30.8%)、支氣管哮喘(2/13,15.4%)、粟粒型肺結(jié)核(1/13,7.7%);24例患者經(jīng)確診后治療上均應(yīng)用十四或十五元環(huán)大環(huán)內(nèi)酯類抗生素,其中紅霉素10例,阿奇霉素9例,羅紅霉素5例,經(jīng)治療后咳嗽、咳痰癥狀明顯緩解,肺部Up音減少。結(jié)論:1、DPB發(fā)病率較低,近些年來,隨著醫(yī)學(xué)的發(fā)展、臨床工作者的努力,我國關(guān)于DPB病例報道陸續(xù)出現(xiàn);2、DPB臨床表現(xiàn)不特異,誤診、漏診率較高,需掌握DPB的臨床特點(diǎn),結(jié)合相關(guān)輔助檢查,提高診斷的準(zhǔn)確性;3、小劑量、長療程十四、十五元環(huán)大環(huán)內(nèi)酯類抗生素治療可改善患者預(yù)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 鹵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 鹵7.71 and 56.49 鹵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 鹵8.27mm Hg,47.85 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R562.21

【相似文獻(xiàn)】

相關(guān)期刊論文 前7條

1 蘇艷仙;;輔助檢查在臨床治療中的重要作用[J];北方藥學(xué);2014年06期

2 李寶霞;尤奎成;;急性一氧化碳中毒輔助檢查的臨床意義[J];醫(yī)學(xué)綜述;2014年13期

3 陳繼超;;急性化膿性闌尾炎誤診一例[J];醫(yī)藥世界;2006年10期

4 邱鴻鐘;;體檢與輔助檢查的效應(yīng)分析[J];醫(yī)學(xué)與哲學(xué);1991年12期

5 胡蝶飛;甄秀梅;黃璐;;輔助檢查項(xiàng)目在不同病因FUO中的分析[J];藥物與人;2014年04期

6 王洪霞 ,李劍;昏厥26例臨床分析[J];中國煤炭工業(yè)醫(yī)學(xué)雜志;2003年06期

7 郝勇;朱宣;李則摯;侯曉軍;管陽太;;神經(jīng)系統(tǒng)輔助檢查臨床教學(xué)體會[J];中國保健營養(yǎng);2013年07期

相關(guān)碩士學(xué)位論文 前1條

1 陳靜;彌漫性泛細(xì)支氣管炎24例臨床分析[D];吉林大學(xué);2017年

，

本文編號：2248797