Panbronchiolitis
Introduction
Introduction to panbronchiolitis Diffuse panbronchiolitis (DPB) is a chronic inflammatory disease of the airway that is diffuse in the respiratory bronchi of both lungs. The affected area is mainly the terminal airway far away from the respiratory bronchioles. Diffuse panbronchiolitis is called because the inflammatory lesions are diffusely distributed and involve the entire layer of the respiratory bronchioles. basic knowledge The proportion of sickness: 0.01%-0.018% Susceptible people: no specific population Mode of infection: non-infectious Complications: emphysema
Cause
Cause of panbronchiolitis
The cause of this disease is unclear so far, the relevant factors are as follows:
1. Infection: DPB patients with chronic sinusitis accounted for more than 80%; patients with DPB had varying degrees of bronchial mucosal lesions or increased airway secretions, showing chronic airway inflammation changes. Therefore, there are opinions that are related to infection. Condensation test is more positive and erythromycin is effective, and it is speculated that it is also associated with Mycoplasma pneumoniae infection.
2. Immune abnormalities related to genetic factors:
1 This disease has a family morbidity.
2HLA-BW54 (human leukocyte antigen BW54) was more positive (63.2%), suggesting that there may be a certain genetic basis. HLA-BW54 is a unique antigen of the Mongolian ethnic group, including the Indians and most Jews, including the Chinese. It is about 14.1% positive in the Japanese and 10.4% positive in the Chinese. Caucasians are extremely rare, and it is speculated that the disease may have a certain ethnic specificity. However, there have been reports of white disease, so the conclusions of this disease related to race and region have yet to be confirmed after summing up a large number of cases in the future. South Korea reports that Koreans have more HLA-B11, so the association between this disease and HLA is not necessarily limited to HLA-BW54. The latest findings suggest that in Japan, DPB patients are highly associated with the B*5401 gene encoding HLA-BW54, the major histocompatibility antigen is HLA-B54-Cwl-A11/24; in Korea, DPB patients are high. HLA-B55-Cwl-A11 and B62-A11 occur at a high frequency, and HLA-A11 is highly correlated with disease. Therefore, Keicho proposed the hypothesis of DPB disease susceptibility gene.
3 The increase in condensate titer is also considered to be related to immune abnormalities.
3. Inhalation of irritating harmful gases and atmospheric pollution: Strong acid fumes, chlorine gas, solvent gases, chemicals and various dusts are prone to cause this disease. For example, the incidence of DPB in areas contaminated with sulfur dioxide is higher than that in the general area.
Prevention
Panbronchiolitis prevention
1, appropriate physical exercise
Enhance physical fitness, improve respiratory resistance, prevent upper respiratory tract infections, avoid inhalation of harmful substances and allergens, and prevent or reduce the occurrence of this disease. Exercise should be gradual and gradually increase the amount of activity.
2, pay attention to climate change and cold season
When the winter season is severe or the climate suddenly becomes cold, pay attention to the clothes and keep warm, add clothes in time, and don't cause colds due to cold. In the cold winter season, the indoor temperature should be 18 ~ 20 °C.
Complication
Complications of panbronchiolitis Complications emphysema
The disease can be complicated by pulmonary edema, sepsis, septic shock, bronchiectasis and other diseases.
Symptom
Pan-bronchiolitis symptoms Common symptoms Coughing chronic cough in winter and spring... Breathing cough after activity
Prominent clinical manifestations are coughing, coughing, and shortness of breath after activity. Severe cases can cause respiratory dysfunction. Clinically easy to be confused with other chronic airway diseases.
Examine
Examination of bronchiolitis
1, chest CT.
2, blood routine.
Diagnosis
Diagnosis and diagnosis of panbronchiolitis
Diagnostic criteria
Diagnostic projects include mandatory and reference projects.
Must be: 1 continuous cough, cough and difficulty breathing during activities; 2 combined with chronic paranasal sinusitis or previous history; 3 chest X-ray see diffuse scattered distribution of two lungs in the form of granular nodular shadow or chest CT see two Diffuse central lobe-like nodular shadows in the diffuse lobules of the lungs. Reference items: 1 chest hearing diagnosis of continuous wet rales; 2 one second forced expiratory volume as a percentage of predicted value (FEV1 is expected to be %) low (less than 70%) and hypoxemia (PaO2 < 80mmHg); The serum condensate concentration test (CHA) has an increased titer (1:64 or more). Diagnosis: Meets required items 1, 2, and 3, plus 2 or more of the reference items. General diagnosis: Meets required items 1, 2, and 3. Suspicious diagnosis: Meets required items 1, 2 .
Pathological diagnosis: it is conducive to the diagnosis of this disease. Gross specimen: The surface of the lung is diffusely distributed with a number of fine gray-white nodules, which are characterized by fine sand-like and granular-like unevenness; the nodules with extensive bronchiole-centered nodules are visible on the cut surface, and bronchiectasis is sometimes seen. Microscopic histopathological features: 1DPB is located in the bronchioles and respiratory bronchioles, while other lung tissue areas can be completely normal; 2 main features are bronchiolitis; 3 characteristic changes are bronchioles, respiratory bronchiol inflammation The bronchioles are narrowed and obstructed; foam-like cells are seen in the alveolar septum and interstitial. The bronchioles, respiratory bronchiol inflammation, showed thickening of the wall, lymphocytes, plasma cells and tissue cells infiltration. It should be noted that typical cases can be diagnosed by X-ray and HRCT; if the clinical and imaging changes are not typical, lung biopsy should be taken. Lung biopsy is best for thoracoscopic or thoracoscopic surgery.
Differential diagnosis:
The differential diagnosis of DPB can be analyzed from three levels: First, starting from a disease with similar clinical manifestations, it needs to be differentiated from diseases such as COPD, bronchiectasis, and bronchial asthma. Second, it can be differentiated from X-ray and CT-like diseases, including COPD, bronchiectasis, miliary tuberculosis, sarcoidosis, pulmonary lymphangiogenesis, alveolar cell carcinoma, and interstitial lung disease. Third, the disease with similar pathological changes is identified. In addition to DPB, inflammatory lesions mainly distributed along the bronchioles include respiratory bronchiolitis with interstitial lung disease (RBILD) and chronic exogenous allergic alveolitis. Their pathological changes are centered on the bronchioles, and both are inflammatory changes, with no characteristic cells for identification. However, RBILD can be seen in the alveolar lumen of the bronchioles and surrounding a large number of macrophage cells; chronic allergic alveolitis should have a large number of lymphocytic infiltration and eosinophil infiltration. When the above characteristics are not very significant, reference should be made to the clinical data, especially the imaging findings to help identify. Such as chronic exogenous allergic alveolitis, when the eosinophil infiltration is not obvious, pathologically and DPB identification is very difficult, but at this time with reference to HRCT changes, the two are completely different: chronic exogenous allergic alveolitis in the middle The patchy shadows or net nodules in the upper lung field are mainly distributed, and the distribution is uneven. There may be fusion: DPB is diffusely distributed in both lungs, the size is very uniform, and the small nodules centered on the small leaves. No fusion. The pathological manifestations of DPB have certain characteristics, and combined with HRCT can make a more accurate diagnosis.
