儿童麻疹肺炎后闭塞性细支气管炎的临床分析

Clinical analysis of post-measles bronchiolitis obliterans in children

目的 通过对儿童麻疹肺炎后闭塞性细支气管炎（B0）的临床资料进行分析,初步探究儿童麻疹肺炎后BO的临床特征、影像学特点及治疗转归.方法 回顾性分析温州市儿童医院2010年7月-2014年5月期间收集的8例麻疹肺炎后BO住院患儿的临床特征、影像学特点、治疗效果及预后.结果 8例均有明确的麻疹肺炎感染史,其后继发腺病毒、支原体肺炎、RSV病毒（合并EB病毒）、副流感病毒感染各1例.胸部HRCT表现有充气不足和过度充气并存8例,马赛克征7例,支气管扩张3例,空气滞留征4例.肺功能检查显示8例均有以小气道为主的阻塞性通气功能障碍,舒张实验阴性.所有患儿均给予全身及局部雾化吸入糖皮质激素治疗,3例联合应用小剂量阿奇霉素口服治疗,1例予常规剂量阿奇霉素静脉注射1周后改口服治疗.随访时间为3个月～2年3个月,根据临床表现评价为好转5例,无好转2例.结论 胸部HRCT可显示麻疹肺炎后BO小气道的特征性病变,是麻疹肺炎后BO诊断和病情随访的重要指标.麻疹肺炎后BO的肺功能检查有一定的诊断价值.糖皮质激素是可能有效的治疗药物,早期诊断治疗有望改善儿童麻疹肺炎后BO的预后.

Objective To study the clinical data of bronchiolitis obliterans （BO） caused by post-measles pneumonia （BO） in children, and explore the clinical features, imaging characteristics, treatment and outcome of BO patients. Methods The clinical data of 8 children with post-measles BO in our hospital between July 2010 and May 2014 was retrospectively reviewed. Results All 8 patients were with definite history of post-measlespneumonia, secondary infections of adenovirus （ 1 cases）, mycoplasma pneumoniae （ 1 cases ）, respiratory syncytialvirus （ 1 case, complicated EBV ） and parainfluenza type 3 virus（ 1 case） were common. The pulmonary HRCT revealed that 8 cases were with decreased density,7 cases with mosaic perfusion,3 cases with bronchiectasis and 4 cases with air retention. The lung function test demonstrated that small airways obstructive ventilation disorder was mainly in all 8 cases, and a negative response to the bronchodilator reversibili- ty testing. All 8 cases received systemic and local inhaled corticosteroid treatment, and 3 cases were orally administered with low doses of azithromycin and 1 case with regular doses of azithromycin ivgtt. All cases were followed up for 3 months to 2 years and 3 months. The clinical manifestations were improved in 5 cases and not in 2 cases. Conclusion The pul- monary HRCT imaging is important for diagnosis of post-measlespneumonia BO. The pulmonary function test has certain diagnostic value for BO. The corticosteroid may be effective for the treatment of post-measles BO. The early diagnosis and treatment will improve the prognosis of children with BO.