原发性纤毛运动障碍致新生儿呼吸窘迫1例并文献复习

Primary ciliary dyskinesia causing neonatal respiratory distress:A case report and literature review

目的报道1例原发性纤毛运动障碍(PCD)患儿的新生儿期临床表现、诊治过程并进行文献复习,以提高对PCD的认识。方法回顾性分析重庆医科大学附属儿童医院收治的1例PCD患儿的临床资料,并检索中国知网、万方数据库、PubMed、Cochrane Library、Online Mendelian Inheritance in Man(OMIM),总结PCD的新生儿期表现。结果本例患儿女,1个月13 d,因“活动后发绀1个月余,咳嗽喘息3周,加重3 d”入院。足月儿,生后1 d出现活动后发绀,后渐出现咳嗽及喘息,因肺炎而加重,住院期间需无创通气,且存在持续CO_(2)潴留,肺炎临床治愈后仍有持续氧依赖。外显子测序提示DNAH1复合杂合突变,结合临床诊断为PCD。检索到PCD导致新生儿呼吸窘迫的病例报道9篇,共12例,均为足月儿,存在不同程度呼吸窘迫,主要表现为气促、胸壁凹陷、呼吸费力、发绀、低氧血症、氧依赖等,其中8例(66.7%)有内脏转位、6例(50.0%)有肺不张、6例(50.0%)需无创或有创机械通气。检索到DNAH1致PCD的文献报道3篇,共9例,其中儿童期确诊7例、成人期确诊2例,主要临床表现包括Kartagener综合征5例(55.5%)、支气管扩张3例(33.3%)、肺不张2例(22.2%)、感染后闭塞性细支气管炎3例(33.3%)、新生儿呼吸窘迫1例(11.1%)、女性不孕1例(11.1%)。结论PCD的新生儿期表现主要为不明原因的呼吸窘迫,且内脏转位和肺不张发病率较高,呼吸支持需求率较高。提高对PCD生命早期表现的认识有助于早期诊断和干预。

Objective To summarize the clinical features,diagnosing and treating passes of a case of primary ciliary dyskinesia(PCD)in newborns,and by literature review to increase awareness of PCD.Methods The clinical data of an infant patient,admitted in Children?s Hospital Affiliated to Chongqing Medical University and diagnosed as PCD,was collected and retrospectively analyzed.CNKI,Wanfang,PubMed,Cochrane Library and Online Mendelian Inheritance in Man(OMIM)were searched,eligible literature was analyzed.Results A term female infant aged 1 month and 13 days was admitted to the hospital with1-month history of cyanosis and 3-week of cough and wheeze,which aggravated 3 days prior to admission.She developed cyanosis on postnatal day 1,then cough and wheeze gradually.Her symptoms deteriorated due to pneumonia,non-invasive ventilation was performed,and continued CO_(2) retention existed.Hypercapnia and oxygen dependence were found throughout the hospital stay even after clinical improvement.Whole exon sequencing test revealed DNAH1 compound heterozygous mutation in this patient,which leaded to the diagnosis of PCD.A total of 9 papers of neonatal respiratory distress caused by PCD were retrieved.All 12 patients in those papers were term infants,presented with varying degree of respiratory distress,which mainly manifested as tachypnea,retractions,elevated work of breath,cyanosis,hypoxemia,oxygen dependence.Of the 12 patients,8(66.7%)had situs inversus viscerum,6(50.0%)had atelectasis,6(50.0%)needed non-invasive or invasive ventilation.A total of 3 papers of PCD caused by DNAH1 mutation with 9 patients were retrieved.Of these patients,7 were diagnosed in childhood and 2 in adulthood.The main clinical manifestations were Kartagener syndrome(55.5%),bronchiectasis(33.3%),atelectasis(22.2%),post-infectious bronchiolitis obliterans(33.3%),neonatal respiratory distress(11.1%),and female infertility(11.1%).Conclusions The clinical features of PCD in neonates are mainly unexplained respiratory distress,higher incidence of situs inversus viscerum and atelectasis,and the demand for respiratory support is high.Raising awareness of the clinical features of PCD in infants is helpful for early diagnosis and intervention.