弥漫性泛细支气管炎误诊为支气管哮喘临床分析

目的探讨弥漫性泛细支气管炎(diffuse panbronchiolitis,DPB)的诊治措施及误诊为支气管哮喘的原因、防范措施。方法回顾性分析误诊为支气管哮喘的DPB 8例的临床资料。结果8例以“发作性喘憋1~2年,呼吸困难加重近1个月”就诊,多次在我院及外院诊断为支气管哮喘,给予相应治疗效果欠佳。后经常规检查及行胸部CT检查发现DPB典型粟粒状结节影,鼻窦CT检查示双上颌窦黏膜增厚,进一步行纤维支气管镜或胸腔镜肺活组织病理检查确诊为DPB。误诊时间1~2年。8例确诊后5例予红霉素治疗,3例予克拉霉素治疗,疗程均6个月。1个月后8例咳嗽、咳痰及呼吸困难症状均明显好转;3个月后复查胸部CT示双肺结节影明显减少或消失,肺功能显著改善。结论DPB以持续性咳嗽、咳痰及活动后气短为主要临床表现,临床误诊率较高。临床医生尤其是低年资医生应加强对DPB的认识,接诊持续性咳嗽、咳痰及活动后气短等高度怀疑DPB患者时,应仔细问诊和查体,及早行相关影像学检查,确诊还需行纤维支气管镜或胸腔镜肺活组织病理检查。

Clinical Analysis of Diffuse Panbronchiolitis Misdiagnosed as Bronchial Asthma

Objective To investigate the diagnosis and treatment of diffuse panbronchiolitis(DPB)as well as the causes and preventive measures of misdiagnosis as bronchial asthma.Methods The clinical data of 8 patients with DPB misdiagnosed as bronchial asthma were analyzed retrospectively.Results Eight patients presented with"asthma onset for 1 to 2 years and dyspnea aggravated for nearly 1 month".They were diagnosed as bronchial asthma in our hospital and other hospitals for multiple times,and the corresponding treatment effect was far from satisfactory.Routine examination and chest CT examination showed typical chestnut nodular shadow of DPB.CT examination of nasal sinuses showed double maxillary sinus mucosa thickening.Further fiberoptic bronchoscopy or thoracoscopic lung biopsy confirmed DPB.The duration of misdiagnosis was 1-2 years.After 8 cases were diagnosed,5 cases were treated with Erythromycin and 3 cases with Clarithromycin.The course of treatment was 6 months.One month later,the symptoms of cough,expectoration and dyspnea were significantly improved in 8 cases.Three months later,chest CT showed that the bilateral pulmonary nodules were significantly reduced or disappeared,and the pulmonary function was significantly improved.Conclusion The main clinical manifestations of DPB are persistent cough,expectoration and shortness of breath after activity,and the misdiagnosis rate is high.Clinicians,especially junior doctors,should strengthen the understanding of DPB.When patients were highly suspected of having DPB for persistent cough,expectoration and shortness of breath after activity,physical examination should be performed carefully,relevant imaging examination should be conducted in the early stage,as well as fiberoptic bronchoscopy or thoracoscopic lung biopsy for diagnosis.