儿童支气管扩张症101例临床分析

Clinical analysis of 101 children with bronchiectasis

目的 探讨儿童支气管扩张症的临床特征,提高儿科医师对该病的认识。方法 回顾性分析2012年1月至2022年4月泉州市儿童医院确诊的101例支气管扩张症患儿的临床表现、影像学、病原学、基因检测等资料。结果 101例支气管扩张症患儿中,男61例,女50例,起病年龄(5.44±4.37)岁,病程(108.47±42.47)d;主要症状为湿性咳嗽(86.14%)、发热(55.45%);肺部CT显示双下叶支气管扩张最常见;39例病原体阳性,肺炎支原体感染(24.75%)最常见;53例行支气管镜检查,23例(43.40%)可见“鱼骨样改变”;15例行肺功能检查,107例为阻塞性通气功能障碍,8例限制性通气功能障碍;15例行基因检测,阳性率为46.67%。最常见的病因是感染(66.34%),其次是支气管异物(4.95%),囊性纤维化(3.96%),闭塞性支气管炎4例(3.96%),原发性纤毛运动障碍(2.97%),免疫缺陷病(2.97%),哮喘(2.97%)。经过治疗,78例(77.23%)临床改善,22例(21.78%)无明显好转,1例(1.00%)死亡。结论 儿童支气管扩张症以湿性咳嗽为主要表现,双下肺最常受累,感染是最主要的病因,支气管异物、囊性纤维化、闭塞性支气管炎、原发性纤毛运动障碍、免疫缺陷病等病因亦不容忽视。

Objective To explore the clinical features of bronchiectasis in children,and to improve pediatricians’understanding of the disease.Methods A total of 101 children diagnosed of bronchiectasis in Quanzhou Children’s Hospital from January 2012 to April 2022 were included in the study.The clinical manifestations,imaging,etiology,gene results were reviewed.Results A total of 101 cases of bronchiectasis in children met the diagnostic criterion,included 61 males and 50 females.The age was(5.44±4.37)years and the time of courses was(108.47±42.47)days.Clinical manifestations included wet cough(86.14%),fever(55.45%);double lower lobe bronchiectasis was most common in CT scans of all the patients;Positive result of sputum or bronchoalveolar lauage fluid were in 39 cases,mycoplasma pneumoniae infection(24.75%)was the predominant pathogen;Bronchoscopy was performed in 53 cases,23 cases(43.40%)showed“fishbone like changes”;15 cases underwent pulmonary function examination pulmonary function showed obstructive ventilation dysfunction in 10 cases,and restrictive ventilation dysfunction in 8 cases;Gene testing was performed in 15 cases,with a positive rate of 46.67%.The most common cause was post infection(66.34%),followed by bronchial foreign body(4.95%),cystic fibrosis(3.96%),bronchitis obliterans(3.96%),primary ciliary dyskinesia(2.97%),immunodeficiency disease(2.97%),and asthma(2.97%).After treatment,78 cases(77.23%)were clinically improved,22 cases(21.78%)were not significantly improved,and 1 case(1.00%)died.Conclusion Wet cough is the main clinical feature of bronchiectasis in children,lower lobes are most involved.Pulmonary infection is the main etiology of bronchiectasis.The causes of bronchial foreign body,cystic fibrosis,bronchitis obliterans,primary ciliary dyskinesia,and immunodeficiency disease cannot be ignored.