儿童哮喘合并迁延性细菌性支气管炎3例临床分析

Clinical analysis of asthma with protracted bacterial bronchitis in 3 children

目的分析儿童哮喘合并迁延性细菌性支气管炎(PBB)的临床特点.方法回顾分析2016年1月至2018年12月确诊哮喘合并PBB患儿的临床资料.结果哮喘患儿3例,女2例、男1例,年龄7~8岁.在规律使用吸入性糖皮质激素过程中出现不同病程(分别为1年、2月余、1月余)的反复咳嗽咳痰喘息,均诊为哮喘未控制,例1给予增加吸入性糖皮质激素剂量及使用全身激素,例2和例3联合使用长效支气管舒张剂,临床症状均未见缓解.经支气管镜检查诊断合并PBB,同时例1合并鼻窦炎、例3合并过敏性鼻炎及腺样体肥大.例1和例3经阿莫西林克拉维酸钾治疗2周联合吸入性糖皮质激素及鼻内激素治疗,例2经4周阿莫西林克拉维酸钾及吸入性糖皮质激素治疗,症状痊愈.结论当哮喘患儿在规律用药时,出现>4周的咳嗽、咳痰、喘息,且对吸入性糖皮质激素和β2-受体激动剂反应不佳,应注意排查有无合并PBB.

Objective To analyze the clinical characteristics of asthma with protracted bacterial bronchitis(PBB)in children.Methods The clinical data of asthma with PBB in children diagnosed from January 2016 to December 2018 were analyzed retrospectively.Results In 3 children(2 girls and 1 boy)aged 7-8 years with asthma,recurrent cough,sputum production and wheeze were presented for 1 year,2 months and 1 month,respectively during regular use of inhaled glucocorticoids and they were misdiagnosed with uncontrolled asthma.Case 1 received an increased dose of inhaled glucocorticoid and systemic hormone,and Case 2 and Case 3 were treated with long-acting bronchodilators,and the clinical symptoms of all children were not relieved.Bronchoscopy showed PBB in all 3 children,and case 1 was combined with sinusitis and case 3 was combined with allergic rhinitis and adenoid hypertrophy.Cases 1 and 3 were treated with amoxicillin-clavulanate for 2 weeks combined with inhaled glucocorticoid and intranasal hormone;Cases 2 was treated with amoxicillin-clavulanate and inhaled glucocorticoid for 4 weeks,and all of them were cured.Conclusions When children with asthma have cough,sputum production and wheezing for more than 4 weeks during regular medication,if they meanwhile have poor response to inhaled glucocorticoids and beta 2-receptor agonists,PBB should be suspected and ruled out.