儿童肺大疱163例临床分析及病因探讨

Clinical analysis and etiology discussion of 163 cases with pulmonary bullae in children

目的探讨儿童肺大疱的临床特点、病因和机制。方法回顾性分析重庆医科大学附属儿童医院1993年3月至2019年8月诊断/疑诊肺大疱住院患儿的病例资料,包括一般情况、病因、病原构成、数目及部位、转归。结果163例患儿中呼吸道感染130例,单纯气胸11例,因其他疾病住院查胸部CT发现肺大疱22例。病原结果:病毒占19.02%(31/163例),以呼吸道合胞病毒为主(9.20%,15/163例);细菌感染占28.83%(47/163例),以流感嗜血杆菌(13/163例,7.98%)和金黄色葡萄球菌(10/163例,6.13%)居多。肺大疱多见于右肺(82例)。肺大疱减少、缩小或消失的时间为7 d^9个月;部分肺大疱间隔19个月后仍无明显变化。结论儿童肺大疱可见于感染、肿瘤、自身免疫性疾病等,以细菌感染居多;肺大疱可能长期存在。肺大疱发生机制包括支气管壁增厚管腔狭窄、远端小血管或毛细血管堵塞致缺血性坏死及肺泡扩张、结缔组织降解及弹性组织离解、细支气管壁破坏、阻碍离子通道及线粒体代谢及破坏上皮细胞连接。

Objective To explore clinical features,etiology and mechanism of pulmonary bullae in children.Methods The clinical data of children with diagnosis or suspected diagnosis of pulmonary bullae,including the general situation,etiology,pathogen composition,number and location,prognosis and so on,in the Inpatient Department of Children′s Hospital of Chongqing Medical University from March 1993 to August 2019 were retrospectively analyzed.Results Among the 163 patients,there were 130 cases of respiratory tract infection,and 11 cases of pneumothorax alone.Totally,22 cases were found pulmonary bullae in the chest CT examination without typical symptoms.Etiology:viruses accounted for 19.02%(31/163 cases),with mainly respiratory syncytial virus(9.20%,15/163 cases);bacterial infection took up 28.83%(47/163 cases),mostly Haemophilus influenzae(13/163 cases,7.98%)and Staphylococcus aureus(10/163 cases,6.13%).Pulmonary bullae was more common in the right lung(82 cases).It took 7 days to 9 months for bullae to reduce,shrink or disappear.In some cases,there was no significant change in bullae even after 19 months.Conclusion Pulmonary bullae can be seen in infection,tumor,auto-immune diseases and so on,most of which are bacterial infections.Bullae may exist for a long time.The mechanism of pulmonary bullae may include the narrowing of lumen,followed by the thickening of bronchial wall,ischemic necrosis and alveolar expansion due to the clogging of distal small vessels or capillaries,the degradation of connective tissue and dissociation of elastic tissue,the destruction of the bronchiolar wall,disturbing ion channels and mitochondria metabolism and destroying the connection of epithelial cells.