70例儿童闭塞性细支气管炎的临床特点和易感因素分析

doi:10.13481/j.1671-587x.20190226

摘要/Abstract

摘要： 目的：总结70例闭塞性细支气管炎（BO）患儿的临床特点，探讨儿童BO的易感因素。方法：选择70例BO患儿（BO组）和同期就诊的200例肺炎患儿（对照组），对其临床资料进行回顾性分析。结果：纳入的70例BO患儿中，男女性别比例2.3：1，诊断BO的年龄集中在婴儿期和幼儿期。BO组3岁以内患儿64例（91.4%），对照组3岁以内患儿32例（16.0%），2组间年龄构成比比较差异有统计学意义（P<0.05）。区域分布，BO组和对照组患儿均以农村为主，BO组农村患儿有41例，城市患儿有29例；对照组农村患儿113例，城市患儿87例；2组间区域构成比比较差异无统计学意义（P>0.05）。在病史和基础疾病方面，BO组患儿中存在重症肺炎、呼吸衰竭、气管插管机械通气和无创呼气末持续正压通气等病史者比例明显高于对照组（P<0.05），且BO组患儿更易并发贫血和先天性心脏病等基础疾病。病原学方面，2组患儿均有肺炎支原体、腺病毒和肺炎链球菌等病原体感染，但BO组患儿腺病毒和真菌感染比例明显高于对照组（P<0.05）。BO组和对照组患儿临床表现为发热、咳嗽和喘息，体征上有三凹征、细湿啰音或哮鸣音；但BO组表现为呼吸困难、反复喘息（通常持续6周至数年）以及运动不耐受症状的患儿比例高于对照组（P<0.05）。与对照组比较，BO组患儿具有特征性的高分辨率CT （HRCT）改变，表现为马赛克灌注征象、支气管扩张征和支气管壁增厚的患儿比例明显高于对照组（P<0.05）。多数BO患儿肺功能提示存在持续的阻塞性通气功能障碍，而对照组多数患儿肺功能检查提示正常，或仅有少数患儿肺功能存在短暂性的轻度改变。结论：重症肺炎和机械通气是BO的主要易感因素。有基础疾病患儿（早产、先天性心脏病和支气管肺发育不良等）如果并发严重肺部感染后易患BO。

关键词: 儿童, 闭塞性细支气管炎, 临床特点, 易感因素

Abstract: Objective: To summarize the clinical characteristics of 70 cases of children with bronchiolitis obliterans(BO), and to explore the susceptibility factors of the children with BO.Methods: A total of 70 children with BO(BO group) and 200 children with pneumonia(control group) were selected.The clinical materials of the children in two groups were retrospectively analyzed.Results: Among the 70 children with BO, the ratio of male to female was 2.3:1,and the age of the diagnosed BO was concentrated in infancy and early childhood;there were 64 cases (91.4%) within 3 years in BO group,32 cases (16%) within 3 years in control group,and the difference in the age composition ratio was statistically significant between two groups (P<0.05).In region distribution,the patients in BO group and control group were mainly in rural areas.There were 41 cases in rural areas in BO group and 29 cases in urban areas,and there were 113 cases in rural areas and 87 cases in urban areas in control group;there was no significant difference in the regional composition ratio between two groups (P>0.05).In terms of medical history and underlying diseases, the proportions of patients with severe pneumonia,respiratory failure,endotracheal intubation and mechanical ventilation, and non-invasive end-expiratory positive pressure ventilation in BO group were significantly higher than those in control group (P<0.05).And the children in BO group were more likely to be associated with the basic diseases such as anemia and congenital heart disease.In pathogens,the patients in two groups were infected with Mycoplasma pneumoniae, adenovirus, and Streptococcus pneumoniae, but the proportions of adenovirus and fungal infection in BO group were significantly higher than those in control group(P<0.05).The clinical manifestations of children in BO group and control group were fever, cough, and wheezing; there were three concave signs, fine wet voices or wheezing sounds on the signs.However, the proportions of children with dyspnea, repeated wheezing (usually lasting for 6 weeks to several years) and intolerance to exercise in BO group were higher than those in control group (P<0.05).Compared with control group,the children with BO had the characteristic high-resolution CT (HRCT) changes, which showed that the proportions of children with mosaic perfusion signs and bronchial wall thickening were significantly higher than those in control group (P<0.05).Pulmonary function in most children with BO suggested persistent obstructive ventilatory dysfunction, while lung function test in of the most of the children in control group suggested normal, or only a few children had transient mild changes in lung function.Conclusion: Severe pneumonia and mechanical ventilation are the main susceptibility factors of BO.The children with underlying diseases (premature birth, congenital heart disease,and bronchopulmonary dysplasia) are prone to BO if they have a serious lung infection.

Key words: children, bronchiolitis obliterans, clinical features, susceptiblility factors

魏娇杨, 尹嘉宁, 马瑜聪, 具杨花, 刘丽. 70例儿童闭塞性细支气管炎的临床特点和易感因素分析[J]. 吉林大学学报(医学版), 2019, 45(02): 364-369.

WEI Jiaoyang, YIN Jianing, MA Yuchong, JU Yanghua, LIU Li. Analysis on clinical characteristics and susceptibility factors of 70 cases of children with bronchiolitis obliterans[J]. Journal of Jilin University(Medicine Edition), 2019, 45(02): 364-369.

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