Clinical study and literature review of bronchiolitis obliterans in children
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摘要: 目的 分析儿童闭塞性细支气管炎(bronchiolitis obliterans,BO)的临床表现、病原学、肺功能、胸部CT、治疗及预后。 方法 对2010年1月—2014年12月在嘉兴市第二医院诊断为BO的17例患儿的临床资料进行回顾性分析,包括年龄、性别、病因、临床表现、肺功能改变、影像学改变、治疗及预后。 结果 17例患儿中,男10例,女7例,均为肺部感染后起病,以腺病毒、麻疹病毒、支原体为其主要的病原体。4例患儿的肺功能检查的结果表现为不可逆性的阻塞性通气功能障碍中度。17例患儿胸部的HRCT均出现马赛克灌注征,5例存在肺实变,3例肺不张,2例支气管扩张,1例支气管壁增厚。所有患儿均使用全身及雾化吸入糖皮质激素治疗,并注意加强肺部理疗,加强营养支持,促进患儿身体全面发育。随访3~27个月,13例患儿对胸部HRCT进行复查,结果显示6例患儿肺部病灶没有改变,2例患儿肺部出现新的病灶区,5例患儿肺部病灶有所减轻,未发现有病灶完全吸收的病例。 结论 呼吸道感染为儿童BO最常见病因,腺病毒、麻疹病毒、支原体是其主要的病原体,肺功能检查对早期BO的诊断没有太大帮助。胸部HRCT显示出来的马赛克灌注征对BO早期诊断和随访有重要意义。全身和吸入糖皮质激素可改善临床症状,BO的预后关键取决于对患儿早诊断、早治疗及身体的全面发育。Abstract: Objective To analyze the clinical features,etiology,pulmonary function,chest CT scans,diagnosis and prognosis of bronchiolitis obliterans(BO) in children. Methods We retrospectively analyzed 17 children with BO in Jiaxing Second Hospital,including their age,gender,etiology,clinical manifestations,changes in lung function,changes in imaging,treatment and outcome. Results All BO cases(10 boys and 7 girls)occurred following lower respiratory tract infection and adenovirus,measles virus and mycoplasma were major pathogens.The lung function test demonstrated that moderate obstructive ventilatory dysfunction happened in 4 cases,and a negative response to the bronchodilator reversibility testing.High-resolution computerized tomography(HRCT)showed mosaic perfusion in a11 cases,lung consolidation in 5 cases,atelectasis in 3 cases,bronchiectasis in 2 cases and bronchial wall thickening in 1 case.All cases received systemic and inhaled corticosteroid treatment and were provided with strengthened lung physiotherapy,a suitable nutrition,and enhanced overall growth and followed up for 3 to 27 months.And 13 cases received chest CT scan and demonstrated that no change was found in 6 cases,2 cases were progressed while 5 cases were improved,and no single case was completely absorbed. Conclusion Low respiratory infection is the most common cause of pediatric BO and adenovirus,measles virus and mycoplasma are major pathogens.The lung function test cannot provide enough early diagnostic value for BO.Classical"mosaic perfusion"with pulmonary HRCT imaging is important for early diagnosis and follow-up of BO.Systemic and inhaled corticosteroid treatment may relieve clinical symptoms,The key to the prognosis of BO is the early diagnosis,early intervention and the overall development of children.
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Key words:
- Bronchiolitis /
- Obliterans /
- Children
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