儿童闭塞性细支气管炎28例临床分析

目的：总结儿童闭塞性细支气管炎（BO）的临床特点，以期提高临床医师对儿童BO的认识。方法：回顾性分析2007年7月至2012年4月经临床诊断为BO的28例住院患儿的临床资料，并随访其预后。结果：所有患儿均表现有反复喘息及咳嗽。感染后闭塞性细支气管炎（PIBO）23例，其中腺病毒肺炎12例，麻疹病毒肺炎和流感病毒A肺炎各2例，肺炎支原体肺炎、腺病毒并肺炎支原体肺炎、呼吸道合胞病毒并副流感病毒3肺炎、肺结核各1例，病原不明3例；非感染性因素导致BO 3例，即Steven-Johnson 综合征、副肿瘤天疱疮、造血干细胞移植后发生BO各1例；病因不明2例。28例胸部HRCT结果示充气不均25例，马赛克灌注征21例，支气管壁增厚15例，支气管扩张12例，气体潴留征6例。21例行肺功能检查，均提示有阻塞性通气功能障碍。18例行舒张试验，17例阴性。所有患儿均使用糖皮质激素治疗，24例口服小剂量阿奇霉素治疗。住院期间死亡1例，18例随访4个月~?4年7个月，临床表现好转12例，无好转5例，死亡1例。结论：下呼吸道感染是儿童BO最常见病因，腺病毒是主要感染病原；BO临床上主要表现为反复喘息、咳嗽，但无特异性；胸部HRCT可显示BO较特征性征象，是BO诊断和病情随访的重要指标；BO肺功能特异性地表现为不可逆的阻塞性通气功能障碍；糖皮质激素、阿奇霉素是可能有效的治疗药物；儿童BO总体预后不好，早期诊断治疗、避免反复呼吸道感染有望改善儿童BO预后。

Clinical analysis of 28 cases of bronchiolitis obliterans

OBJECTIVE: To study the clinical features of bronchiolitis obliterans (BO) in children. METHODS: The clinical data of 28 children with BO between July 2007 and April 2012 was retrospectively reviewed. RESULTS: All patients presented with persistent or repeated cough and wheezing. Twenty-three cases were post-infectious bronchiolitis obliterans (PIBO), among whom the etiology were adenovirus (12 cases), measles (2 cases), influenza virus A (2 cases), mycoplasma pneumoniae (1 case), mycoplasma pneumoniae coinfection with adenovirus (1 case), respiratory syncytial virus coinfection with Parainfluenza type 3 virus (1 case) and pulmonary tuberculosis (1 case). The etiology of 3 cases was not associated with infection. The etiology was unknown in 2 cases. Pulmonary HRCT revealed that decreased density in 25 cases, mosaic perfusion in 21 cases, bronchial wall thickening in 15 cases, bronchiectasis in 12 cases and air retention in 6 cases. Lung function test was performed on 21 cases and demonstrated that obstructive ventilation disorder in all 21 cases. Bronchodilation test was performed on 18 cases and 17 cases showed a negative result. All 28 cases received corticosteroid treatment, and 24 cases were orally administered with low doses of azithromycin. One case died during hospitalization. Eighteen cases were followed up for 4 months to 4 years and seven months. Clinical manifestations were improved in 12 cases and one case died. CONCLUSIONS: Low respiratory infection is the most common cause of pediatric BO and adenovirus is a major pathogen. Persistent wheezing and cough were main clinical manifestations. Pulmonary HRCT imaging is important for diagnosis and follow-up of BO. Lung function test can typically show obstructive ventilation disorder. Corticosteroid and methotrexate may be effective for treatment of BO. Prognosis of this disease is unsatisfactory. Early diagnosis and treatment, and avoidance of repeated respiratory tract infection may be helpful to improve the prognosis.