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目的分析小儿闭塞性细支气管炎(BO)的临床特点。方法回顾性分析本院呼吸科2004年10月-2009年9月诊断为BO的7例患儿的临床表现、胸部X线及高分辨率CT(HRCT)、病原学、肺功能及治疗和转归等。结果 7例患儿均表现为呼吸道感染后慢性咳喘、气促。病程1.5个月～7 a。查体:双肺均可闻及湿性啰音或喘鸣音。X线胸片:双肺纹理增粗或肺炎表现。肺部HRCT均呈现Mosaic灌注征,其中支气管扩张1例。肺功能:5例均为阻塞性通气功能障碍,舒张试验阴性。病原学:5例发病前患麻疹肺炎,1例患肺炎支原体肺炎,1例患肺炎腺病毒肺炎并真菌感染。支气管镜:2例无特殊表现。治疗及转归:1例有明显支气管扩张放弃治疗,1例因治疗过程中出现支气管扩张而放弃治疗,余5例患儿用激素或加服小剂量阿奇霉素,病情均有好转。结论BO的临床表现以慢性咳嗽、喘息为特点,肺部HRCT呈现特异的Mosaic灌注征,肺炎支原体、腺病毒尤其是麻疹病毒感染后可继发BO,肺功能为阻塞性通气功能障碍。BO的诊断主要依据典型的临床表现、肺部HRCT和肺功能检查。
Objective To analyze the clinical features of pediatric obliterative bronchiolitis (BO). Methods The clinical manifestations, chest X-ray and high resolution CT (HRCT), etiology, pulmonary function and treatment and management of 7 children diagnosed as BO were analyzed retrospectively in our department from October 2004 to September 2009. Equal. Results All the 7 patients showed chronic cough and asthma after shortness of breath infection and shortness of breath. Duration of 1.5 months ~ 7 a. Physical examination: both lungs can smell wet rales or wheezing. X-ray: thickening of lungs or pneumonia. Pulmonary HRCT showed signs of Mosaic perfusion, including bronchiectasis in 1 case. Pulmonary function: 5 cases were obstructive ventilatory dysfunction, diastolic test was negative. Etiology: Five cases of pre-morbid measles pneumonia, one case of Mycoplasma pneumoniae pneumonia, and one case of pneumonia with adenovirus pneumonia and fungal infection. Bronchoscopy: 2 cases without special performance. Treatment and outcome: 1 case had obvious bronchiectasis to give up treatment, 1 case due to bronchial dilation during treatment and give up treatment, the remaining 5 cases of children with hormones plus small doses of azithromycin, the condition has improved. Conclusions The clinical manifestation of BO is characterized by chronic cough and wheezing. HRCT of lung shows a characteristic Mosaic perfusion sign. Mycoplasma pneumoniae, adenovirus especially measles virus may be associated with secondary BO, pulmonary function obstructive ventilatory dysfunction. The diagnosis of BO is mainly based on typical clinical manifestations, pulmonary HRCT and pulmonary function tests.