CAJ | 학술논문

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.
목적 탐토인동감염후폐새성세지기관염(bronchiolitis obliterans,BO)림상특정、지기관폐포관세(bronchoalveolar lavage,BAL)료효급관세액(BAL fluid,BALF)세포학특점.방법 절강대학의학원부속인동의원10례진단위BO적환인,균행섬유지기관경검사.분석기병원、림상특정、폐고분변CT(HRCT)、혈T세포아군、BALF세포학특점급BAL료효.결과 10례균위중증폐염후BO,병원위선병독4례,폐염지원체4례,마진1례.소유환자균표현반복혹지속천식、해수、기촉,량폐엄범효명음화습라음.폐HRCT제시마새극정6례(6/10),량폐염증반간질변4례(4/10),반기체저류3례,지기관확장、폐불장、지기관벽증후각1례.혈CD8+T세포증고9례(9/10)、CD4+/CD8+비치하강10례(10/10).BALF중성립세포분류균명현증고(10/10).BAL치료후,9례림상증상급체정균명현개선이출원.결론 선병독화폐염지원체시인동감염후BO적주요병원,세포면역공능곤란도치기도염증손상가능삼여BO적발병궤제;혈CD8+T세포급BAL중성립세포명현증고예시BO적발생;BAL치료가명현개선BO증상.
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.