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目的通过分析弥漫性泛细支气管炎(diffuse panbronchiolitis,DPB)的临床特点及误诊为肺结核的原因,提高对两种疾病的鉴别诊断能力。方法对11例误诊为肺结核的DPB临床特点及误诊原因进行回顾性分析。结果 11例患者主要症状为长期咳嗽、咳痰及气促,均合并有慢性副鼻窦炎,胸部影像表现主要为两肺弥漫性散在分布的颗粒样结节状或粟粒状阴影,肺功能检查结果为阻塞性通气功能障碍及低氧血症,3例血清冷凝集试验(CHA)效价增高(1∶64以上),11例均被误诊为血行播散性肺结核,抗结核药物治疗无效而大环内酯类抗生素治疗病情好转明显。结论误诊原因主要是对DPB缺乏认识,以及DPB与肺结核在临床表现与胸部X线影像表现相似。对诊断为血行播散性肺结核患者经抗结核治疗效果不佳且痰抗酸杆菌阴性时,结合临床表现应考虑到DPB。
Objective To analyze the clinical features of diffuse panbronchiolitis (DPB) and the causes of misdiagnosis as pulmonary tuberculosis, and to improve the ability of differential diagnosis of the two diseases. Methods The clinical features and misdiagnosis of 11 cases of misdiagnosed pulmonary tuberculosis were retrospectively analyzed. Results The main symptoms of 11 patients were long-term cough, expectoration and shortness of breath, both of which were complicated by chronic sinusitis. The chest imaging mainly consisted of diffuse scattered nodular or miliary shadow in both lungs. The pulmonary function test results For obstructive ventilatory dysfunction and hypoxemia, 3 cases of serum coagulation test (CHA) titer increased (1:64 and above), 11 cases were misdiagnosed as hematogenous disseminated pulmonary tuberculosis, anti-tuberculosis drugs ineffective and large Lactone antibiotics improved condition significantly improved. Conclusion The main reasons for misdiagnosis are the lack of understanding of DPB and the similar clinical manifestation and chest X-ray findings between DPB and tuberculosis. For patients diagnosed with hematogenous disseminated pulmonary tuberculosis by anti-TB treatment is poor and sputum acid-fast bacilli negative, combined with clinical manifestations should take into account the DPB.