<原著>慢性気道疾患の検討 : びまん性汎細気管支炎の気管支造影像を中心に

Abstract

Since Honma and associates reported that "diffuse panbronchiolitis (DPB)" should be separated from other chronic obstructive pulmonary diseases, and should be a new disease entity, there have been much debate with regard to its definition and clinicopathological features of the chronic respiratory tract disease. Ninety three cases with various chronic airway diseases were tentatively grouped into five; DPB, bronchiectasis (BE), middle lobe-lingula syndrome (MLS), centrilobular emphysema (CE). and chronic bronchitis (CB), based on our own criteria. These five groups of disease were studied on bronchographic findings (SAB and liquid-filled alveolography) roentgenologic findings of paranasal sinuses, smoking history, titers of serum cold hemagglutinin (CHA) and IgA, and sputum bacteriology. These findings were evaluated to correlate to each group of diseases. In DPB, BE, and MLS, disorders of paranasal sinuses were often observed, smokers were rare, titers of serum CHA and IgA were significantly elevated, and Hemophilus influenzae was often cultured from their sputa. It was our impression that from the bronchographic findings in 29cases, in DPB, a congenital deficiency of defense mechanisms in whole range of respiratory tract seemed to cause primarily chronic infection in respiratory bronchioles due to their intrinsic morphologic features, and in due time, bronchiolar obstructions ensued, and again infections complicated. The inflammation may expand gradually upward and bronchiectasis may at times develop. It is likely that DPB, BE and MLS belong to the same group of disease which might have a congenital deficiency of defense mechanisms of respiratory tract. In contrast to this group, in CE, disorders of paranasal sinuses were observed rarely, and almost all patients were smokers, titers of serum CHA and IgA were not significantly elevated, and Hemophilus influenzae has never been cultured from sputum. Therefore, CE seems to belong to an another group of disease which might be caused by exogenous irritants, for example, smoking. The concept of so called "chronic bronchitis (CB)" is at times intermingled with those two groups of disease, which causes much confusion in understanding respiratory tract disorders. Chronic bronchitis should be meticulously evaluated and classified, if possible, into one of these two groups of disease.