4例闭塞性毛细支气管炎临床分析

Clinical feature of four cases with bronchiliotis obliterans

目的 了解闭塞性毛细支气管炎的临床特征。方法 对近年临床诊断为闭塞性毛细支气管炎的 4例病例进行临床表现、胸部X线和CT、肺功能特点、治疗转归的分析。结果 2例为Stevens johnson综合征后 ,1例为腺病毒肺炎后 ,1例在外院诊为重症肺炎。症状 :慢性咳嗽、气促、喘息 ,持续均在 6周以上。体征 :4例均有双肺湿啰音、喘鸣音?叵咝仄?:4例均为过度通气表现。肺CT :均有斑片影、支气管壁增厚 ,局限性气体潴留 3例、小支气管扩张 2例、肺不张 1例、Mosaic灌注 1例。肺功能 :4例均有小气道阻力增加、氧分压不同程度降低。治疗及转归 :用 β2 激动剂及其他支扩剂治疗无效 ,3例使用了激素治疗。对其中 2例 3～ 4个月后随访 ,1例病情改善 ,三凹征和喘鸣音消失。另 1例病情无明显改善 ,仅喘鸣音消失。 2例肺CT均无改善。结论 闭塞性毛细支气管炎的临床以慢性咳嗽、喘鸣音为特点 ,对 β2 激动剂治疗无反应。胸X线片为过度通气表现 ,肺CT可显示更多的病变 。

Objective To recognize the clinical features of the bronchiolitis obliterans. Method Clinical manifestation, chest X-ray, computed tomography (CT) and pulmonary function of 4 cases with bronchiolitis obliterans were retrospectively analyzed. Result Two cases were after Stevens-Johnson syndrome (SJS), the other 2 were after severe pneumonia, including one suffered from adenovirus pneumonia. Cough, tachypnea and wheezing persisted in all the 4 patients. The symptoms lasted for at least 6 weeks, in one case for over one year. Crackles and wheezing were present in all the 4 cases. Hyperinflation was seen in chest radiographs in all cases. On pulmonary CT/high-resolution CT (HRCT), patchy opacity and bronchial wall thickening were seen in each patient. Areas of air trapping were seen in three cases. Bronchiectasis was seen in 2 cases, atelectasis and mosaic perfusion were seen respectively in one case. PO 2 was low in all the four cases. Wheezing was not responsive to β 2 agonist and other bronchodilating therapy. Prednisone was used at a dose of 1 mg/(kg·d) in 3 cases. Two cases were followed up for 3 months. The clinical condition of one case was improved, whose wheezing and bronchiolar constriction disappeared, cough and dyspnea were also relieved. However, the condition of one patient was not improved, although the wheezing disappeared. The HRCT of these two cases showed no improvment. Conclusion Clinical symptoms of BO were cough, tachypnea, and wheezing after acute lung injury. Crackles and wheezing were the most common signs in the BO. Chest radiographs showed hyperinflation. Pulmonary CT showed bronchial wall thickening, bronchiectasis, atelectasis, and mosaic perfusion. Pulmonary function tests suggested obstruction of small airway.