迁延性细菌性支气管炎的病例对照分析

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摘要目的：对照分析迁移性细菌性支气管炎（PBB）的临床特征及病原学特点。方法：回顾性分析2014年6月至2016年12月温州医科大学附属第二医院育英儿童医院收治的湿性咳嗽＞4周，并行支气管镜检查和支气管肺泡灌洗液（BALF)细菌培养及细胞学检查的98例患儿的临床资料。BALF细菌培养阳性和（或）中性粒细胞升高，抗菌药物治疗2周咳嗽明显好转者归为PBB组（50例），不符合PBB诊断标准者归为非PBB组（48例）。结果：PBB组男36例，女14例，中位年龄3.2岁，与非PBB组比较差异无统计学意义（P＞0.05）；平均住院时间（7.0±1.0）d，明显长于非PBB组（P＜0.05）。PBB组30例伴喘息，占60%，明显高于非PBB组（P＜0.05）；6例（占12%）合并气管狭窄，5例（占10%）合并气管-支气管软化，14例合并鼻窦炎。PBB组BALF中性粒细胞比例为0.63（0.50，0.82），显著高于非PBB组（P＜0.01)，肺炎链球菌（n=19）为主要致病菌，其次为流感嗜血杆菌（n=5）。PBB患儿均接受2～4周抗感染治疗，其中48例（占96.0%）口服阿莫西林/克拉维酸钾。随访1年，其中23例（占47.9%）PBB复发。结论：PBB好发于婴幼儿，易伴喘息，可合并鼻窦炎。肺炎链球菌为主要致病菌，阿莫西林/克拉维酸钾为首选的治疗药物。

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	李嫦嫦
	董琳
	夏永强
	张海邻
	胡晓光
	郑仰明

关键词 ：咳嗽, 支气管炎, 支气管肺泡灌洗液, 儿童

Abstract：Objective: To analyze the clinical characteristics and etiology in children with protracted bacterial bronchitis (PBB) confirmed by bronchoscopy. Methods: The hospitalized children who had over 4 weeks cough from June 2014 to December 2016 were investigated retrospectively. The children were defined as PBB (n=50) who had a chronic wet cough without signs of an alternative specific cause and responding to 2 weeks of appropriate antibiotics, had positive bacterial culture and/or increased of neutrophils in bronchoalveolar lavage fluid (BALF). Those did not fulfill the above criteria were divided into the ‘no PBB group’ (n=48). Results: In the PBB group, there were 36 boys and 14 girls. The median (IQR) age was 3.2 (2.0~4.0) years and 58.0% cases were under 3 years. Thirty children were accompanied by wheezing. Airway malacia were found in five cases. The average of neutrophils in BALF was 0.63 (0.50, 0.82), which was significantly higher than that in the control group (P<0.01). 36 isolates were identified from BALF in children with PBB, the common pathogens were Streptococcus pneumoniae (n=19), Haemophilus influenzae (n=5) and Moraxella catarrhalis (n=4). All children received a 2~4 weeks course of antibiotics. The majority (n=48) received oral amoxicillin/clavulanic acid. Twenty-three cases (47.9%) had a recurrent PBB by 1 year follow-up. Conclusion: PBB occurs mainly in younger children and often co-exist with wheezing. Streptococcus pneumoniae is the leading pathogen in children with PBB. Amoxicillin/clavulanic acid is the major treatment for PBB.

Key words： cough bronchitis bronchoalveolar lavage fluid child

收稿日期: 2018-01-05

通讯作者: 董琳，主任医师，硕士生导师，Email：donglin@wzhealth.com。

作者简介: 李嫦嫦（1992-），女，浙江温州人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I11/837

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