儿童迁延性细菌性支气管炎28例临床分析  

Clinical features of protracted bacterial bronchitis in children

作　　者：迟繁繁 王宇清[1] 郝创利[1] 孙惠泉[1] 范丽萍[1] 黄莉[1] 于兴梅[1] 杨晓蕴[1] 陆燕红[1] 周菁[1] 陆权[2] 

机构地区：[1]苏州大学附属儿童医院呼吸科,215003 [2]上海交通大学附属儿童医院呼吸科

出　　处：《中华儿科杂志》2015年第10期784-787,共4页Chinese Journal of Pediatrics

基　　金：中华医学会临床医学慢性呼吸道疾病科研专项资金课题（08020760154）;苏州市科技发展计划项目（社会发展）（SS201423）

摘　　要：目的 探讨儿童迁延性细菌性支气管炎（PBB）的临床特征.方法 回顾性分析2010年10月至2014年3月苏州大学附属儿童医院呼吸科收治的咳嗽＞4周、并行纤维支气管镜检查,其支气管肺泡灌洗液（BALF）细菌培养阳性和（或）BALF中性粒细胞比例升高的患儿的临床资料.结果 符合PBB入选标准患儿28例,其中男26例（93％）,女2例（7％）;年龄中位数为8.5个月.咳嗽病程中位数为4.2周.患儿平均住院时间为（8.3±3.9）d.主要临床特征为湿性咳嗽28例,其中湿性咳嗽＋喘息21例;湿性咳嗽时相分布特征为昼夜无规律14例.肺部体征主要为哮鸣音＋湿哕音21例.外周血中CD3-CD16＋ 56＋比例升高.纤维支气管镜下表现主要为管腔黏膜充血水肿,同时11例患儿合并气道软化.BALF的中性粒细胞中位数0.2;BALF培养细菌阳性率为36％,检出的细菌主要为肺炎链球菌（50％）和流感嗜血杆菌（30％）.治疗主要予阿莫西林克拉维酸或二代头孢抗感染,平均疗程为（17.3 ±3.2）d,预后较好.结论 儿童PBB以男性儿童多见,临床特征为湿性咳嗽,多伴有喘息,感染病原菌以肺炎链球菌和流感嗜血杆菌为主,可伴有气道软化.Objective To analyze the clinical characteristics of protracted bacterial bronchitis （PBB） in children.Method The clinical data of patients seen from October,2010 to March,2014 in Department of Respiratory Diseases of our hospital were retrospectively analyzed.Inclusion criteria were over 4 weeks cough,receiving fiberoptic bronchoscopy,positive bacterial culture and （or） the increased percentage of neutral granulocytes in bronchoalveolar lavage fluid （BALF）.Result Twenty eight patients were involved,26 were male （93%） and two were female （7%）.The median age of patients was 8.5 months.The median duration of cough was four weeks.The average length of hospital stay was （8.3 ± 3.9） days.The main clinical feature was wet cough in 28 cases,wet cough with wheezing was seen in 21 cases.The wet cough phase distribution was irregular in 21 cases.The crackles with wheeze （in 21 cases） was main signs of PBB.The percentage of CD3-CD16 ＋ 56 ＋ cells increased in peripheral blood.The fiberoptic bronchoscopic manifestations of PBB were luminal mucosal edema.Eleven patients also had airway malacia.The neutrophil median in BALF was 0.2.The positive rate of bacterial culture of BALF was 36%.The main bacteria were Streptococcus pneumoniae （50%） and Haemophilus influenzae （30%）.The main treatment for PBB patients included amoxycillin/clavulanate potassium and second-generation cephalosporins.The average duration of treatment was （17.3 ± 3.2） days,the prognosis was good.Conclusion PBB is common in male infants.Persistent wet cough with wheezing was the main characteristic of PBB.PBB is commonly accompanied by immune dysfunction and airway malacia,and the pathogens were Streptococcus pneumoniae and Haemophilus influenzae.

关 键 词：儿童 咳嗽 支气管炎 支气管肺泡灌洗液 

分 类 号：R725.6[医药卫生—儿科]