儿童腺病毒肺炎并闭塞性细支气管炎形成的早期预测  

Early predictors of childhood adenovirus pneumonia associated with bronchiolitis obliterans

作　　者：吴星[1] 刘爽[1] 周长江[1] 苗永红[1] 曹振锋[1] 赵琼丹 WU Xing;LIU Shuang;ZHOU Chang-jiang;MIAO Yong-hong;CAO Zhen-feng;ZHAO Qiong-dan(Department of Pediatrics,Henan Province People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院儿科,郑州450000

出　　处：《医药论坛杂志》2020年第4期38-41,共4页Journal of Medical Forum

基　　金：河南省科技攻关计划项目(142102310425)。

摘　　要：目的通过对儿童腺病毒肺炎后闭塞性细支气管炎(bronchiolitis obliterans,BO)临床特点分析,提高对腺病毒肺炎后闭塞性细支气管炎的早期识别能力。方法回顾性分析河南省人民医院2017年1月至2019年1月期间收治的18例腺病毒肺炎患儿的临床资料,依据后期是否形成BO分为BO组和非BO组,对两组患儿的临床特征,实验室结果,影像学特点,纤维支气管镜诊治,治疗效果及预后进行分析,了解腺病毒肺炎合并BO形成的早期预测指标。结果 BO组在热程,住院时间,肺泡灌洗液(bronchoalveolar lavage,BAL)IL-8水平,对丙种球蛋白的敏感性,纤维支气管镜有效率,CD8^+T细胞水平与非BO组相比,差异有统计学意义(P<0.05),而WBC计数,LDH水平,感染状态,早期肺部HRCT表现两组之间无明显差异(P>0.05)。结论 IL-8,CD8^+T细胞参与腺病毒肺炎后BO的形成,热程长,丙种球蛋白治疗效果差,提示后期形成BO可能性大,纤维支气管镜肺部介入或灌洗术可减轻临床症状,改善预后。Objective To enhance the early recognicion of bronchiolitis obliterans,BO through analyzing its clinical features in children. Methods This study, by reviewing the clinical meterials of 18 children cases with BO, who were being treated in Henan Provincial Hospital from Januray 2017 to Juany 2019, attempts to make an analysis of the the clinical characteristics, lab results, iconography characteristics, fiber bronchoscope treatments, the effects of treatments as well as the prognosis of the two groups of children cases(The group was seperated in accordance with whether they developed into BO or not in late stages of their disease), so as to know the early predicting indicators of the formation of adenovirus pneumonia combined with BO.Results The BO group is sensitive to gamma globulin in thermal process, bronchoalveolar lavage,BAL IL-8 level and it is efficient with fiber bronchoscope treatments. Compared with the non-BO group, the CD8^+T cell level is significant statiscally(P<0.05). wherease, the WBS count, LDH level, length of hospital stays, the state of affection and the early HRCT performance in lungs are not evidently different(P>0.05).Conclusion the thermal process of the formation of IL-8,CD8^+T cell counts and adenovirus post BO is long. The treating effect of gamma globulin is not good which indicates a high likelyhood of the formation of BO in the late stage. The involvement of fiber bronchoscope in lungs or lavage may alliviate the clinical symptoms and improve its prognosis.

关 键 词：腺病毒肺炎 闭塞性细支气管炎 IL-8 丙种球蛋白 

分 类 号：R563.12[医药卫生—呼吸系统]