闭塞性细支气管炎31例

Clinical Study of 31 Children with Bronchiolitis Obliterans

目的明确小儿闭塞性细支气管炎(BO)的临床特点、治疗措施及随访结果。方法对2008年4月-2011年6月在本科明确诊断为BO患儿的临床资料进行归纳、总结,对其治疗效果进行随访分析。结果 31例患儿反复咳嗽及喘息均>6周,查体肺部听诊可闻及哮鸣音和(或)粗湿啰音。入院给予雾化吸入支气管扩张剂无反应。31例患儿均存在肺功能异常,24例患儿为阻塞性通气功能障碍,7例患儿肺功能示混合性通气功能障碍;31例肺CT均存在Mosaic灌注征、双肺均可见斑片状密度增高影,肺不张6例,支气管壁增厚5例,支气管扩张2例。31例X线胸片均有过度通气表现,可见斑片状密度增高影,4例呈毛玻璃样改变。患儿均口服泼尼松、阿奇霉素并配合雾化吸入布地奈德及沙丁胺醇。对其中26例患儿进行2个月～3 a随访,规律治疗的6例患儿临床症状明显改善,无明显喘息发作,活动耐力好转,复查肺部高分辨率CT示肺部病变明显改善;10例临床症状略好转,仍有活动后气促,复查肺部高分辨率CT示肺部病变轻微改善;10例患儿依从性差,未按医嘱规律用药及回访,病情经常反复,于呼吸道感染后出现喘息发作,于本院住院3～6次,临床疗效欠佳,复查肺部高分辨率CT示肺部病变无改善,现仍在随访中。结论 BO大多为肺部感染后引起的反复咳嗽、喘息,肺部听诊可闻及明显的呼气相哮鸣音,吸入支气管扩张剂效果不佳,肺功能大多表现为阻塞性通气功能障碍,CT可见肺部典型的Mosaic灌注征。本病预后不佳。

Objective To define the clinical characteristics,treatment and follow-up of bronchiolitis obliterans（BO） in children. Methods Clinical analysis and follow-up were analyzed from the data of 31 patients with BO who were diagnosed and treated in the Department of Pediatrics,the First Hospital of Jilin University from Apr.2008 to Jun.2011. Results All the children presented with persistent cough and wheezing for more than 6 weeks.Crackles and wheezing were hearded in all cases.After admission,all the children had no response to inhalation bronchodilator.Pulmonary function abnormalities were present in 31 children,24 cases with obstructive ventilatory dysfunction,7 cases showed mixed ventilatory dysfunction.Pulmonary CT existed Mosaic perfusion,and patchy high density shadow could be seen in 31 cases,atelectasis in 6 cases,bronchial wall thickening in 5 cases,and bronchiectasis in 2 cases.Thirty-one cases were performed hyperventilation,and X-ray exhibited patchy increased density,4 cases showed frosted glass performances.All the patients received oral prednisone,azithromycin and inhalation of salbutamol and budesonide.After a follow-up study in 26 cases,6 cases experienced regular treatment were significantly improved in clinical presentation,pulmonary imaging and function;10 cases were ameliorated in clinical presentation,pulmonary imaging and function;the rest showed poor compliance,and failed to taking regular medication,because their parents feared the side effects of oral steroids to children,these 10 children showed the disease recurrence,and dued to wheezing following respiratory infection,who admitted to the hospital 3-6 times within 2 months to 3 years,exhibited poor clinical efficacy,and pulmonary CT revealed no improvement.And long-term follow-up study was still in progress. Conclusions In most of the patients,post-infected BO exhibited repeated coughing,wheezing,significantly expiratory wheezing could be heard in lungs,bronchodilator was ineffective.Lung function mostly showed obstructive ventilatory dysfunction,and pulmonary CT revealed a typically mosaic performance.Most of the cases had a poor outcome.