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目的提高对儿童弥漫性泛细支气管炎的认识。方法回顾性分析上海市肺科医院2005—2007年期间收治的3例儿童弥漫性泛细支气管炎患者的临床表现、相关实验室检查结果、肺功能和影像学表现以及治疗效果。结果儿童弥漫性泛细支气管炎的临床表现包括持续性咳嗽、咯痰、气促,肺部啰音,可伴有慢性副鼻窦炎。实验室检查显示本文3例血清冷凝集实验均为阴性,1例抗核抗体及类风湿因子弱阳性,免疫球蛋白IgG和IgM可升高,痰培养可见绿脓杆菌生长。肺功能检查提示通气功能减退,并有低氧血症。高分辨率CT(HRCT)主要表现为两肺弥漫分布小叶中心结节,伴细支气管扩张和管壁增厚。阿奇霉素治疗后临床症状、肺功能或CT评分改善。结论弥漫性泛细支气管炎可发生于儿童,儿科医生应熟悉该病的临床和放射学表现,尤其是HRCT特征性表现,以确保患儿早期诊断,早期给予大环内酯类药物治疗。
Objective To raise awareness of diffuse bronchiolitis in children. Methods The clinical manifestations, laboratory tests, pulmonary function and imaging findings of 3 patients with diffuse panbronchiolitis admitted to Shanghai Pulmonary Hospital from 2005 to 2007 were retrospectively analyzed. Results The clinical manifestations of diffuse bronchiolitis in children included persistent cough, expectoration, shortness of breath, pulmonary rales and chronic sinusitis. Laboratory tests showed that the three cases of cold coagulation experiments were negative, anti-nuclear antibodies and rheumatoid factor in 1 case weakly positive, immunoglobulin IgG and IgM can be increased, sputum culture showed Pseudomonas aeruginosa growth. Pulmonary function tests suggest hypoventilation and hypoxemia. High-resolution CT (HRCT) mainly manifested as diffuse distribution of the two lobular heart nodules, with bronchiectasis and wall thickening. Clinical symptoms, lung function or CT scores improved after azithromycin treatment. Conclusions Diffuse panbronchiolitis can occur in children. Pediatricians should be familiar with the clinical and radiological manifestations of the disease, especially the characteristic features of HRCT, so as to ensure the early diagnosis of patients and the early administration of macrolides.