儿童闭塞性细支气管炎特征及支气管肺泡灌洗  

Post-infectious bronchiolitis obliterans in children： clinical features and bronchoalveolar lavage therapy

作　　者：钟永兴[1] 卢美萍[1] 陈志敏[1] 鲍兴儿[1] 陈莲香[1] 唐兰芳[1] 祝国红[1] 

机构地区：[1]浙江大学医学院附属儿童医院呼吸科,杭州310003

出　　处：《中华急诊医学杂志》2010年第11期1188-1192,共5页Chinese Journal of Emergency Medicine

基　　金：浙江省自然科学基金资助项目（Y2090339）;国家自然科学基金资助项目（81070012）

摘　　要：目的 探讨儿童感染后闭塞性细支气管炎（bronchiolitis obliterans,BO）临床特征、支气管肺泡灌洗（bronchoalveolar lavage,BAL）疗效及灌洗液（BAL fluid,BALF）细胞学特点.方法 浙江大学医学院附属儿童医院10例诊断为BO的患儿,均行纤维支气管镜检查.分析其病原、临床特征、肺高分辨CT（HRCT）、血T细胞亚群、BALF细胞学特点及BAL疗效.结果 10例均为重症肺炎后BO,病原为腺病毒4例,肺炎支原体4例,麻疹1例.所有患者均表现反复或持续喘息、咳嗽、气促,两肺广泛哮鸣音和湿啰音.肺HRCT提示马赛克征6例（6/10）,两肺炎症伴间质变4例（4/10）,伴气体潴留3例,支气管扩张、肺不张、支气管壁增厚各1例.血CD8^＋T细胞增高9例（9/10）、CD4^＋/CD8^＋比值下降10例（10/10）.BALF中性粒细胞分类均明显增高（10/10）.BAL治疗后,9例临床症状及体征均明显改善而出院.结论 腺病毒和肺炎支原体是儿童感染后BO的主要病原,细胞免疫功能昆乱导致气道炎症损伤可能参与BO的发病机制;血CD8^＋T细胞及BAL中性粒细胞明显增高预示BO的发生;BAL治疗可明显改善BO症状.Objective To investigate the clinical features and bronchoalveolar lavage （BAL）therapy of postinfectious bronchiolitis obliterans （BO） in children. Method Ten children, who had post-infectious BO from February 2009 to February 2010, received BAL therapy, and were retrospectively analyzed. The data included pathology,chnical feature,chest HRCT scan, BALF cellular, levels of blood T cell subtypes and outcome of BAL therapy. Results Adenoviruses or mycoplasma pneumoniae were the most common etiologic agents （4/10, respectively）. All patients presented persistent or recurrent dyspneic respirations and wheezing since the initial lung infection. The findings of HRCT included mosaic pattern of perfusion （6/10）, accompanied by gas retention,bronchiectasis, atelectasis and bronchial wall thickening. The percentage of neutrophils in BALF was significantly increased in all cases （10/10）. There were predominance of CD8^＋ T cell subtype （9/10） and lower ratio of CD4 ^＋/CD8^＋ （ 10/10）in blood. Reduced symptoms and shortened hospital stay of BO in 9 of all 10 cases were observed after BAL therapy. Conclusions Severe adenovirus or mycoplasma pneunoniae bronchiolitis and/or pneumonia has higher risk for developing BO in children. Increased percentage of neutrophils in BALF and predominance of CD8^ ＋T cell subtype may play an important role in the mechanism of BO. BAL therepy can reduce the respiratory symptoms of BO in children.

关 键 词：闭塞性毛细支气管炎 感染 支气管肺泡灌洗 中性粒细胞 T细胞 

分 类 号：R725.6[医药卫生—儿科]