儿童弥漫性泛细支气管炎3例分析并文献复习

目的提高对儿童弥漫性泛细支气管炎的认识。方法回顾性分析上海市肺科医院2005—2007年期间收治的3例儿童弥漫性泛细支气管炎患者的临床表现、相关实验室检查结果、肺功能和影像学表现以及治疗效果。结果儿童弥漫性泛细支气管炎的临床表现包括持续性咳嗽、咯痰、气促,肺部啰音,可伴有慢性副鼻窦炎。实验室检查显示本文3例血清冷凝集实验均为阴性,1例抗核抗体及类风湿因子弱阳性,免疫球蛋白IgG和IgM可升高,痰培养可见绿脓杆菌生长。肺功能检查提示通气功能减退,并有低氧血症。高分辨率CT(HRCT)主要表现为两肺弥漫分布小叶中心结节,伴细支气管扩张和管壁增厚。阿奇霉素治疗后临床症状、肺功能或CT评分改善。结论弥漫性泛细支气管炎可发生于儿童,儿科医生应熟悉该病的临床和放射学表现,尤其是HRCT特征性表现,以确保患儿早期诊断,早期给予大环内酯类药物治疗。

Childhood diffuse panbronchioHtis:report of three cases and review of the literature

Objective To improve cognition for pediatric diffuse panbronchiolitis.Methods Totally 3 children with DPB were collected from 2005 to 2007 in Shanghai Pulmonary Hospital,and analyzed the clinical manifestations,related lab test results,the pulmonary and imaging manifestations and treatment effects.Results The clinical findings included productive cough,sputum,dyspnea,rhonchi and chronic sinusitis.The pulmonary function tests showed an obstructive pattern.High resolution computed tomography showed a diffuse nodular pattern,airway ectasia,and airway wall thickening.Elevation of cold agglutinin was seen in none of our three cases.Azithromycin treatment was introduced,resulting in clinical and functional improvement.Conclusion DPB can occur in children.Its clinical and radiological features,especially the special findings by HRCT,should be better known by pediatric pulmonary physicians,so that an earlier diagnosis can be made and treatment with macrolides can be given earlier.