287例婴幼儿喘息病因分析及诊断策略

Retrospective analysis on etiology and a diagnosis strategy for infants with wheezing:a report of 287 cases

目的探讨3岁以内婴幼儿喘息的病原学感染谱、过敏原检测谱及疾病谱分布及其诊断策略。方法回顾性分析新疆医科大学第一附属医院287例3岁以内患喘息性疾病婴幼儿临床资料,均进行详细的病史采集及查体,并完善血常规、病原学检查、过敏原筛查、胸片,必要时完善肺功能、肺部CT+气道三维重建及纤维支气管镜等检查,结合预后,综合分析疾病谱。结果 3岁以内婴幼儿喘息病原学感染谱依次为乙型流感病毒、呼吸道合胞病毒、副流感病毒、腺病毒、肺炎支原体、嗜肺军团菌、巨细胞病毒等;过敏原检测谱依次为屋尘螨/粉尘螨、牛奶、鸡蛋、榆树、霉菌、葎草、豚草、艾蒿、梧桐等;综合临床资料确定诊断,疾病谱依次为支气管肺炎、毛细支气管炎/喘息性支气管炎、婴幼儿哮喘、间质性肺炎、支气管狭窄、先天性喉软骨发育不全、支气管异物、肺隔离症、食道裂孔疝、支气管肺发育不良、肺门淋巴结结核、先天性心脏病、纵隔肿瘤、淋巴瘤、肺部肿瘤等。根据病因进行治疗,部分患儿转相关科室治疗,所有婴幼儿均获治愈或不同程度好转。结论支气管肺炎是最常见的婴幼儿喘息性疾病,在病原学检查中,感染比例最高的是乙型流感病毒,过敏体质婴幼儿应尽量避免接触屋尘螨/粉尘螨等过敏原,综合病原学感染谱、过敏原检测谱及疾病谱,给予患儿最佳的治疗方案。

Objective To analyze the pathogenic microorganism, allergen and diagnosis from the clinical data with wheezing in infants, and to explore its diagnostic strategy. Methods Clinical data of 287 patients with wheezing in infants in our hospital between Jan 2010 and Jan 2013 were analyzed retrospectively. All patients were investigated though history inquiring, physical examination, blood cell count, pathogenic microorganism examination, allergen examination and chest radiograph, and some patients were given pul- monary function tests, 3--dimensional computed tomography reconstruction of chest and flexible broncho- scopy for complex cases. Results In this study,287 cases of wheezing infants were infected with Influenza B virus, respiratory syncytial virus, parainfluenza virus, adenovirus, mycoplasma pneumoniae, legionella pneumophila and cytomegalovirus in sequence; Allergen detection spectrum was house dust mites/dust mites, milk, eggs, elm, fungi, humulus scandens, ragweed, mugwort and phoenix tree in sequence; The disease spectrum involved were bronchopneumonia, capillary bronchitis/asthmatic bronchitis, infant asthma, interstitial pneumonia, bronchial stenosis, congenital laryngeal cartilage dysplasia, bronchial foreignbody, isolated lung disease, hiatal hernia, bronchial pulmonary hypoplasia, lung door lymph node tuber- culosis, congenital heart disease, mediastinal tumor, lymphoma, lung cancer, and etc. All patienls were cured or improved after treatment based on the etiology. Conclusion Bronchial pneumonia is the most common diseases for infants with wheezing, Influenza B virus is the most important pathogenic etiological examination. Allergic infants should try to avoid contact with house dust mites/dust mites and other allergen. According to the etiology and diagnostic strategy, the infants can get the best treatment.