| Objective: To retrospectively analyze and summary the clinical data of the inpatients with diffuse panbronchiolitis(DPB),and investigate the clinical characteristics of DPB patients,to provide the basis for early diagnosis,reduction of misdiagnosis and rational treatment of DPB.Methods: We collected the clinical data of patients with DPB who had been hospitalized for treatment and admitted to first affiliated hospital of guangxi medical university between June 1,2006 and July 1,2020,which was confirmed basing on the diagnostic criteria proposed in 1998 by a working group of the Ministry of Health and Welfare of Japan or histopathological examination.SPSS26.0 was used to statistical analyze the collected data.Results:1.A total of 41 patients with confirmed DPB were included,27 females and14 males.the ratio of a male to female was 0.52:1.There were 21 cases of Han nationality,18 cases of Zhuang nationality and 2 cases of other nationalities.Occupation: 22 cases of farmers(77.27% of female),9 cases of retired personnel,2 cases of workers(including auto repair workers),1 case each of teachers and self-employed persons,3 cases each of students and other occupations.The Age of onset was 46.36±18.38 years,the mean age of the DPB patients at diagnosis was(54.27±16.12)years,which were mainly between 60 and 69 years old.The main clinical manifestations were chronic cough,sputum,shortness of breath after activity,and some patients have other symptoms,for example fever,chest pain,hemoptysis sputum or hemoptysis.On physical examination,39 cases had wet rales in the lungs,and 17 cases had dry rales.The course of disease ranged from 20 days to 40 years,38 cases had a course of more than 3 months,1 case had a course of less than 1 month,and 2 cases had a course of 1-3 months.The average clinical history was(8.37±8.49)years.3 cases had a history of chronic sinusitis,6 cases with smoking history.2.Cold agglutination test was performed on 20 patients,the titer ratio of 2 cases(10%)was increased by 1:64 or above,which was 1:64 and 1:128 respectively.25 cases of Mycoplasma pneumoniae antibody Ig M were detected,3 cases(30%)were positive.The sputum culture were collected with 36 cases of DPB,Pseudomonas aeruginosa were cultured in4 cases(11.11%),Kleentsbsiella pneumoniae and Stenotrophomonas maltophilia were collected from 1 case.3.Pulmonary function examination had been completed with 40 cases,39 cases had airflow limitation and severe small airway dysfunction,17 cases had obstructive ventilate dysfunction,29 cases had diffusion dysfunction.The mean values of forced expiratory volume in the first second/forced vital capacity,residua volume/total lung volume,FEF75%pred,FEF50%pred,FEF25%pred,MMEF was 57.82(17.91),49.17(27.42),13.10(16.70),13.60(10.30),20.30(15.50)and 13.30(10.10).32 cases(78.05%)of bronchodilation test,9.38% DPB was positive and 90.62% were negative,bronchial provocation test of 2.44% DPB were negative.41cases(100%)had hypoxemia,and 8 cases(19.51%)had hypercapnia,mean Pa O2 and Pa CO2 was 66.30(15.10)and 41.00(10.89)respectively.4.Sinus CT of DPB suggest sinusitis with 39 patients(95.12%).CT mainly showed diffuse nodular and patchy lesions,23 cases(56.10%)with bronchiectasis,11 cases showed typical changes of tree bud sign.transbronchial lung biopsy was performed in 12 cases,1 case were examined by thoracotomy and lung biopsy,2cases(15.38%)were diagnosed by transbronchial lung biopsy and thoracotomy lung biopsy respectively.5.41 patients(100%)had been misdiagnosed as pulmonary infection,chronic bronchitis,bronchiectasis,chronic obstructive pulmonary disease,bronchial asthma,secondary tuberculosis at the first visit.DPB patients of 40 cases were treated with long-term low-dose macrolides after the diagnosis was confirmed,including 34 cases of erythromycin,5 cases of azithromycin,and 1 case of clarithromycin,1 case was diagnosed as invasive hydatidiform mole(I: 4)and received methotrexate monotherapy.38 cases(95%)improved after treatment,the symptoms of cough,sputum,and shortness of breath after exercise were relieved and the lung soung reduction,3 cases of the symptoms and signs did not improve significantly.6.The follow-up of 28 cases had been completed,the follow-up ranged from 7 months days to 7 years,18 cases were improved,3 cases were not recovered after regular medication,2cases showed progression and 5 cases died.During the follow-up,6 patients developed exacerbations,2 patients died of respiratory failure due to disease progression,all of them had irregular short-term medication history,and 4cases(50.00%)with bronchiectasis.Conclution:1.Most of DPB were female farmers,most of them were after 40 years old,it has little to do with smoking and the course of the disease was prolonged.2.Most of DPB were complicated with sinusitis and bronchiectasis,almost all of them were misdiagnosed and missed at the initial diagnosis,fully understanding the clinical features of DPB is helpful for diagnosis.3.The diagnosis of DPB mainly depends on the comprehensive analysis of history,chest and paranasal sinus CT,pulmonary function test and other indicators.DPB pulmonary function test has obvious characteristics: manifested as severe small airway dysfunction and obstructive ventilation dysfunction.4.It is effective to regularly use low-dose macrolide for DPB. |
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