儿童闭塞性细支气管炎42例临床分析

目的 探讨儿童闭塞性细支气管炎的临床特点.方法对北京儿童医院2001年4月-2007年8月诊断闭塞性细支气管炎的42例患儿进行分析,内容包括患儿年龄、性别、临床表现、病因、肺功能改变、影像学改变、治疗及随访预后等方面.结果 42例患儿(男31例,女11例)诊断时年龄最小的7个月,最大的12岁2个月,均以持续咳嗽、喘息为主要表现.肺部体征有喘鸣音及湿性啰音.病因为感染后32例(76.2%),其中考虑为腺病毒肺炎者8例(占感染后闭塞性细支气管炎的25%),考虑为麻疹肺炎者7例(占感染后闭塞性细支气管炎的21.9%),考虑为呼吸道合胞病毒感染者2例(占感染后闭塞性细支气管炎的6.2%).病因为Steven-Johnson综合征的4例(9.5%).骨髓移植后1例(2.4%).肺功能表现为小气道阻塞性通气功能障碍35例(89.7%),混合性通气功能障碍4例(10.3%).肺CT有典型的马赛克灌注征者34例(81.0%),支气管扩张14例(33.3%),支气管壁增厚14例(33.3%),肺不张4例(9.5%),合并Swyer-James综合征2例(4.8%).所有患儿均予皮质醇激素、小剂量红霉素或阿奇霉素口服治疗,辅以糖皮质激素和支气管扩张剂吸入,或白三烯受体拮抗剂口服治疗.随访1个月至5年,除2例临床表现及影像检查、肺功能有一定程度好转外,其余患儿均有不同程度的加重,死亡1例.结论儿童闭塞性细支气管炎多为感染后起病,其特征性的临床、影像学和肺功能表现基本可以确定诊断.该病预后不佳.

Clinical studies of children with bronchiolitis obliterans

Objective Bronchiolitis obliterans (BO) is a chronic airflow obstruction syndrome associated with inflammatory lesions of the small airways.The etiology,pathogenesis,effective treatment and prognosis of this disorder remain uncertain by now.There has been no large scale clinical research on BO in China.This study aimed to analyze the clinical characteristics of BO in childrern.Methods Clinical analysis was done on data of 42 patients (31 boys and 11 girls,aged from 7 months to 12 years and 2 months) with bronchiolitis obliterans diagnosed and treated in Beijing Children's Hospital from April 2001 to August 2007.The diagnostic criteria included typical clinical manifestations,specific pulmonary CT imaging and lung function tests.Results All the patients presented with persistent cough and wheezing.Crackles and wheezing were heard in most cases.Thirty-two (76.2%) cases were post-infectious BO,among whom 8 (25%) were supposed to be adenovirus pneumonia,7 (21.9%) measles pneumonia and 2 (6.2%) respiratory syncytial virus infection.In 4(9.5%) cases BO occurred after Steven-Johnson syndrome,and 1 (2.4%) after bone marrow transplantation.The constrictive obstruction in Bmall airway occurred in 35 cases (89.7%),while mixed pattern in 4 (10.3%).Pulmonary CT revealed mosaic perfusion in 34 cases (81.0%),bronchiectasis in 14 cases (33.3%),bronchial wail thickening in 14 eases (33.3%),atelectasis in 4 cases (9.5%) and Swyer-James syndrome in 2 cases (4.8%).All the cases received oral corticosteroid and low doses of erythromycin or azithromycin,with corticosteroid and bronchodilator inhalation or oral montelukast.Follow up time was from 1 month to 5 years.Besides 2 cases in whom the disease was ameliorated in clinical presentation,pulmonary imaging and function,the rest experienced deterioration and one died.Conclusion In most of the patients BO occurred following infections.The specific clinical presentations,imaging and pulmonary function are sufficiently informative for diagnosis.Most of the cases enrolled in this study had a poor outcome.