Hu Xiaowen, Yi Eunhee Suh, Ryu Jay Hoon
Anhui Medical University, Anhui Provincial Hospital, Hefei, China. Division of Respiratory Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
Mayo Clinic College of Medicine, Rochester, MN, USA. Mayo Clinic College of Medicine, Rochester, MN, USA.
J Bras Pneumol. 2015 Mar-Apr;41(2):161-6. doi: 10.1590/S1806-37132015000004516.
Aspiration can cause a variety of pulmonary syndromes, some of which are not well recognized. The objective of this study was to assess the demographic, clinical, radiological, and histopathological correlates of diffuse aspiration bronchiolitis (DAB), a bronchiolocentric disorder caused by recurrent aspiration.
This was a retrospective study of 20 consecutive patients with DAB seen at the Mayo Clinic in Rochester, Minnesota, between January 1, 1998 and June 30, 2014.
The median age of the patients was 56.5 years (range, 22-76 years), and the male/female ratio was 2.3:1.0. In 18 patients, the diagnosis of DAB was based on the results of a lung biopsy; in the 2 remaining patients, it was based on clinical and radiological features, together with documented aspiration observed in a videofluoroscopic swallow study. In 19 patients (95%), we identified predisposing factors for aspiration, including gastroesophageal reflux disease (GERD), drug abuse, and dysphagia. Common presenting features included cough, sputum production, dyspnea, and fever. Twelve patients (60%) had a history of recurrent pneumonia. In all of the patients, chest CT revealed bilateral pulmonary infiltrates consisting of micronodules and tree-in-bud opacities. In the majority of patients, interventions aimed at preventing recurrent aspiration (e.g., anti-GERD therapies) led to improvement in the symptoms of DAB.
Young to middle-aged subjects with recognizable predisposing factors for aspiration and who report a history of recurrent pneumonia are at increased risk for DAB. Although DAB is not well recognized, certain chest CT features are characteristic of the disorder.
误吸可导致多种肺部综合征，其中一些尚未得到充分认识。本研究的目的是评估弥漫性误吸性细支气管炎（DAB）的人口统计学、临床、放射学和组织病理学相关性，DAB是一种由反复误吸引起的以细支气管为中心的疾病。
这是一项对1998年1月1日至2014年6月30日期间在明尼苏达州罗切斯特市梅奥诊所连续就诊的20例DAB患者进行的回顾性研究。
患者的中位年龄为56.5岁（范围22 - 76岁），男女比例为2.3:1.0。18例患者的DAB诊断基于肺活检结果；其余2例患者的诊断基于临床和放射学特征，以及视频透视吞咽研究中记录的误吸情况。19例患者（95%）存在误吸的诱发因素，包括胃食管反流病（GERD）、药物滥用和吞咽困难。常见的临床表现包括咳嗽、咳痰、呼吸困难和发热。12例患者（60%）有反复肺炎病史。所有患者的胸部CT均显示双侧肺部浸润，表现为微结节和树芽征。大多数患者中，旨在预防反复误吸的干预措施（如抗GERD治疗）使DAB症状得到改善。
具有可识别的误吸诱发因素且有反复肺炎病史的中青年人群患DAB的风险增加。尽管DAB尚未得到充分认识，但某些胸部CT特征是该疾病的特征性表现。
