闭塞性支气管炎与闭塞性细支气管炎临床特征对比分析

Comparative analysis of clinical characteristics of bronchitis obliterans and bronchiolitis obliterans

目的分析儿童闭塞性支气管炎、闭塞性细支气管炎临床特征的差异,以达到对闭塞性支气管炎的早期识别、早期治疗。方法收集2021年1月至12月期间就诊于重庆医科大学附属儿童医院的确诊闭塞性支气管炎及闭塞性细支气管炎的患儿,分为单纯闭塞性支气管炎组、单纯闭塞性细支气管炎组及闭塞性支气管炎合并闭塞性细支气管炎组(简称合并组),对比其临床特点、实验室检查、影像学检查结果及治疗。结果单纯闭塞性支气管炎组发病年龄高于另2组;单纯闭塞性细支气管炎组喘息、反复喘息、气促、活动不耐受、呼吸困难、三凹征表现较单纯闭塞性支气管炎组更明显;合并组喘息、反复喘息、气促、活动不耐受症状较单纯闭塞性支气管炎组明显;单纯闭塞性支气管炎组呼吸音减弱较单纯闭塞性细支气管炎组明显;单纯闭塞性支气管炎组肺泡灌洗液中细胞总数、有核细胞数、中性粒细胞数、淋巴细胞数、吞噬细胞数、胸腔积液占比较单纯闭塞性细支气管炎组多;单纯闭塞性支气管炎组灌洗液中淋巴细胞数较合并组多,单纯闭塞性支气管炎组肺功能障碍程度较另2组轻,使用有创呼吸机占比较另2组少。结论儿童闭塞性支气管炎临床表现与闭塞性细支气管炎类似,但闭塞性支气管炎表现普遍较闭塞性细支气管炎轻,肺功能障碍程度也较轻。支气管镜检查与肺泡灌洗液中细胞总数、中性粒细胞数可能是鉴别的线索。支气管镜灌洗治疗及针对性的积极抗感染治疗,可能对避免此类患儿进一步发展成支气管闭塞有帮助。

Objective To analyze the clinical characteristics of bronchitis obliterans in children,and to discuss the differences between its clinical characteristics and those of bronchiolitis obliterans,so as to achieve early recognition and treatment of bronchitis obliterans.Methods The clinical data of those children who were diagnosed with bronchitis obliterans and bronchiolitis obliterans in Children's Hospital Affiliated to Chongqing Medical University from January 2021 to December 2021 were collected.The patients were divided into simple bronchitis obliterans group,simple bronchiolitis obliterans group and bronchiolitis obliterans combined with bronchiolitis obliterans group(referred to as combination group).The clinical characteristics,laboratory examination,imaging examination results and treatment were compared.Results The onset age of simple bronchitis obliterans group was higher than that of the other two groups.The symptoms of wheezing,repeated wheezing,shortness of breath,activity intolerance,dyspnea and three concave signs in simple bronchiolitis obliterans group were significantly more obvious than those in simple bronchitis obliterans group;the symptoms of wheezing,repeated wheezing,shortness of breath and activity intolerance in combination group were more obvious than those in simple bronchitis obliterans group;the reduction of breath sound in simple bronchitis obliterans group was more obvious than that in simple bronchiolitis obliterans group;The total number of cells,nuclei,neutrophils,lymphocytes,phagocytes and pleural effusion in alveolar lavage fluid of simple bronchitis obliterans group were more than those of simple bronchiolitis obliterans group;the number of lymphocytes in lavage fluid of simple bronchitis obliterans group was more than that of combination group;the degree of pulmonary dysfunction of simple bronchitis obliterans group was less severe than that of the other two groups,and the use of invasive ventilator was less than that of the other two groups.Conclusion The clinical manifestations of children with bronchitis obliterans are similar to those of bronchiolitis obliterans,but the manifestations of bronchitis obliterans are generally less severe than those of bronchiolitis obliterans,and the degree of pulmonary dysfunction is also less severe.Bronchoscopy and the total number of cells and neutrophils in alveolar lavage fluid may be clues for identification.Bronchoscopic lavage therapy and targeted and aggressive anti-infective therapy may be helpful in preventing further development of bronchial occlusion in these patients.