78例儿童支气管扩张症的临床特征分析

A clinical analysis of bronchiectasis in 78 children

目的总结支气管扩张症患儿的临床特征,提高诊疗水平,改善预后。方法回顾性分析2010年1月至2020年1月在青岛大学附属妇女儿童医院诊断治疗的78例支气管扩张症患儿的临床资料,对其年龄及区域分布、病因、临床表现、肺部高分辨率CT检查结果、肺功能特点、支气管镜检查结果以及治疗预后进行分析。结果78例支气管扩张症患儿中,男35例(44.9%),女43例(55.1%),中位年龄8.7(6.1,9.0)岁;农村患儿51例(65.4%),城市患儿27例(34.6%),农村儿童发病率高于城市儿童。引起支气管扩张症的前3位病因为:感染后40例(51.3%),原发性免疫缺陷病9例(11.5%),吸入因素7例(9.0%)。主要临床表现为湿性咳嗽、咳脓痰、喘息、反复呼吸道感染。肺部高分辨率CT显示弥漫性支气管扩张症36例(46.2%),局限性支气管扩张37例(47.4%)。49例(62.8%)存在肺通气功能异常。接受支气管镜检查61例(78.2%),其中49例(80.3%)镜下存在"鱼骨样"改变。经治疗原发病、抗感染、支气管镜检查及肺泡灌洗、祛痰及物理治疗,67例好转出院并接受1年以上随访。其中55例症状好转,12例反复呼吸道感染,3例死亡。结论儿童支气管扩张症的临床表现没有明显特异性,早期诊断、识别病因和综合管理,对其预后至关重要。

Objective To analyze the clinical features of bronchiectasis,in order to improve the diagnosis,treatment,and prognosis.Methods The clinical data of 78 children with bronchiectasis at Qingdao Women and Children′s Hospital of Qingdao University from January 2010 to January 2020 were analyzed,including age,regional distribution,etiology,clinical manifestations,lung function characteristics,results of lung high-resolution CT,results of fiberbronchoscopy examination,treatment,and prognosis.Results Among 78 children with bronchiectasis,there were 35 males(44.9%)and 43 females(55.1%),with a median age of 8.7(6.1,9.0)years.There were 51 children in rural areas(65.4%)and 27 children in urban areas(34.6%).The incidence of children in rural areas was higher than that in urban areas.The top three causes of bronchiectasis were 40(51.3%)cases after infection,nine cases(11.5%)of primary immunodeficiency and seven cases(9.0%)of inhalation.The main clinical manifestations were wet cough,expectoration,wheezing and repeated respiratory infection.High-resolution CT of the lungs showed 36(46.2%)cases with diffuse bronchiectasis and 37(47.4%)cases with localized bronchiectasis.Forty-nine(62.8%)cases had abnormal pulmonary ventilation function.Sixty-one(78.2%)cases were treated with fiberoptic bronchoscopy,of which 49(80.3%)cases had"fishbone"changes.After anti-infection,fiberbronchoscopy examination,expectorant and physical therapy,67 cases were discharged and followed up for more than one year.Among them,55 cases had symptoms improved,12 patients had recurrent respiratory tract infection,and three patients died.Conclusion The clinical manifestations of bronchiectasis in children have no obvious specificity.Early diagnosis,identification of the cause and comprehensive management are critical to prognosis of bronchiectasis.