Epidemiology of bronchiolitis

The concept of DPB was first put forward by Japanese Benji and shinya yamanaka in the world. In the process of studying emphysema from 65438 to 0969, they found seven new independent diseases with respiratory bronchioles as the main lesion, and named them diffuse panbronchiolitis. 1980- 1982, the Japanese Ministry of Health and Welfare organized a national survey of 1 DPB, and 3 19 cases were diagnosed, and 82 cases were pathologically diagnosed as DPB. 65438-0988, DPB Health and Welfare Research Class organized the second domestic survey in Japan [3], and 229 cases were diagnosed. Since 1990s, cases have been reported in South Korea, Taiwan Province Province, Singapore and other Asian countries and regions, and sporadic cases have also been reported in Italian, British, French, American and other western countries, but more than half of them are Asian immigrants. Therefore, DPB is currently considered as a disease mainly occurring in East Asia. From 65438 to 0990, Fraser described DPB in the 3rd edition of Diagnosis and Diseases of Chester, and DPB became a new disease recognized by the world. In 1996 China Journal of Tuberculosis and Respiratory Diseases, Chinese mainland, Liu Youning and Wang Houdong reported 1 case of DPB (TBLB and open lung biopsy) respectively. By the end of 2002, there were 78 cases reported in mainland literature, and the reported cases so far did not exceed 100. Our department has treated more than 70 cases in recent 6 years.

Some scholars believe that DPB may be a global disease, but there are differences between people and regions, and it is more common in East Asia represented by Japan, South Korea and China. At present, there is a lack of survey data on global incidence. According to the epidemiological investigation data in Japan, the characteristics of DPB are summarized as follows: ① the disease is spread all over Japan, with no regional distribution difference; ② Sex of disease: the ratio of male to female is 1.4∶ 1, which is slightly higher for males. If the rate of medical treatment is considered, there is no significant difference between the sexes; ③ The onset age ranged from10 to 80 years old, with the peak of 40 to 50 years old, and the estimated prevalence rate was 1 1/65438+ 10,000; ④ The incidence is not closely related to inhalation of irritating gas and smoking; ⑤84.8% patients had chronic sinusitis or previous history, and 20.0% patients had family history of chronic sinusitis. But the onset time has nothing to do with the onset of chronic sinusitis and the operation time. ⑥ Other respiratory diseases, such as chronic bronchitis, bronchiectasis, bronchial asthma, emphysema, etc., were mostly diagnosed at the initial stage, accounting for 90%, while only 65,438+00.0% were diagnosed as DPB.

Chinese mainland lacks large-scale epidemiological data. The author made a preliminary analysis of 78 cases reported at the end of 2002. The results are as follows: the incidence of male patients is higher than that of female patients; More north and less south; They are all Han people; More than 90% have paranasal sinusitis; Has nothing to do with smoking; Family attack tendency is not obvious; Most condensation tests are positive; HLA-B54: 1 1 case, 5 cases were positive; Lower respiratory tract infection bacteria: Pseudomonas aeruginosa accounts for the vast majority, and a few are Klebsiella pneumoniae and Haemophilus influenzae; Pulmonary function changes: most of them are moderate obstructive ventilation disorder, most of them have normal diffusion function, and a few of them are reduced; The misdiagnosis rate of initial diagnosis is about 75%, but it gradually decreases with time, indicating that the understanding of this disease has improved; Most macrolide antibiotics have a good prognosis.

Jian Kang and others retrospectively analyzed 40 cases of DPB reported in Chinese mainland in 2005, and found that there were more males than females (365,438+0/40). It is distributed all over the country; Most of them have paranasal sinusitis (37/40); 12 cases detected HLA-BW54, and 5 cases were positive (4 1.6%). 75% patients were misdiagnosed before the diagnosis of DPB. The clinical, imaging and pathological features of DPB patients in Chinese mainland are similar to those of Japanese patients.

The data of 70 patients in our hospital at the end of 2006 have the following characteristics: 1, and the ratio of male to female is 1.6: 1. The age ranged from 265438 0 to 80 years, with an average age of 53 65438 04 years. 2. All cases have cough; 95.8% cases had expectoration; Shortness of breath accounted for 91.6%; 87.5% were accompanied by emphysema. 3.9 1.6% had paranasal sinusitis and 25% had secondary bronchiectasis. 4. Pseudomonas aeruginosa is the most complicated bacterial infection (41.6%); Followed by haemophilus parainfluenzae (16.6%) and Klebsiella pneumoniae (12.5%). 5.75% patients were initially misdiagnosed as chronic bronchitis, and 79.2% patients were misdiagnosed as bronchiectasis. 6. Not closely related to HLA-B54. HLA-B54 was detected in 1 1 patients, and only 3 cases were positive (27.3%). 7.5 patients (7.65438 0%) had family aggregation. 8. The time from onset to diagnosis ranged from 1 year from 6 months to 40 years, with a median time of 7 years. 9. The correct rate of first diagnosis increased from 0% of 200 1 to 75% in 2006, and the total correct diagnosis rate reached 62.5%; 10, and the short-term effective rate of comprehensive treatment based on macrolide antibiotics reached 96%.