Bronchiolitis Obliterans In Children Of 54 Cases Of Clinical Analysis And Followup

Background: Bronchiolitis obliterans(BO)in children is the one that infection or other factors damage bronchiolitis,show with over 6 weeks cough,wheezing,with or without difficulty breathing,exercise intolerance,have serious influence on children’s physical mental health and quality of life,which is chronic airflow limited syndrome.Lung biopsy is the diagnosis gold standard,according to the pathology classification,including narrow sex bronchiolitis and proliferative bronchiolitis.Study found there are many different kinds of epidemic factor of BO,including infection,autoimmune diseases,toxic substances to inhale,etc.Because lung biopsy in pediatric clinical difficult to implement,it is not conducive to early diagnosis.Clinical mainly rely on clinical feature and lung HRCT to make the diagnosis,so make the diagnosis and treatment of behind,leading to poor clinical curative effect,poor prognosis,bad influence on children’s physical and mental health,family burden heavier.Objective:Summarizing and analyzing the clinical characteristics,treatment and prognosis of BO children,for the early diagnosis,early treatment and prognosis of BO judgment,provide a reference basis.Methods: Collection the clinical data of 54 children with bronchiolitis obliterans,who inpatiented in Hunan Children’s Hospital on May 2011 to August 2015(sex,age at diagnosis,clinical symptoms and signs,situation of birth),auxiliary examination including respiratory virus antigen seven detection,measurement of T lymphocyte subsets,allergen detection,fiber bronchoscope examination,BALF cell counting,pulmonary function,pulmonary HRCT and so on,follow-up telephone and outpatient service ways.The collected data were analyzed retrospectively,and draw a conclusion.Results:(1)In 54 cases,male 43 cases(79.6%),female 11 cases(20.4%),the male constituent ratio is higher than female.Age distribution,the average diagnostic age is 1.3 ± 1.2 years old,and 0.5~1 years old age group(40.7%)is significantly higher than other age groups.Clinical manifestations mainly show with continuous or repeatedly cough,wheezing,and can show with anhelation,exercise intolerance,lung auscultation wet rale and wheezing,only 2 cases with finger clubbing.22 children need mechanical assisted ventilation(including endotracheal intubation and noninvasive ventilation),17 cases need nasal catheter on oxygen.(2)Factors of BO is given priority to with infection.Viral infections of 22 cases(40.74%),its component ratio is higher than other risk factors;In the aspect of source of infection,pneumonia mycoplasma infection of 10 cases(18.52%),the composition of it than second only to the ADV,and followed by measles and bacteria.30 cases with allergen test,suggests BO children is given priority to with allergies.19 cases with T lymphocyte subsets,suggests the main performance for CD4+T cells(94.7%).12 cases with pulmonary function examination,suggests the lung function is given priority to with obstructive ventilation dysfunction.54 children with lung CT are characterized by Mosaic perfusion,inflatable uneven,of a few mergers bronchiectasis,bronchial wall thickening and other signs.38 cases with fiber bronchoscope examination,all show the bronchial infective endocarditis.(3)52 cases after discharge were be budesonide+terbutaline aerosol therapy,assisted other symptomatic support treatment.54 cases in clinic and telephone follow-up.Followed up to 50 cases,shortest follow-up of 0.5 years,the longest 5.7 years,the average follow-up time was 2.84 ± 1.13 years.11 cases with symptoms and lung CT improved(20.4%),20 cases with cough improvement(37.0%),16 to cough and gasp the symptoms not seen improved(29.6%),3 cases died(5.6%).Conclusion:(1)The children BO is well distributed in infants aged from 0.5 to 1,and males are higher than females.(2)The children BO is the main infection.mycoplasma pneumoniae causes the incidence of children’s disease,secondary to the adenovirus.(3)The incidence of clinical symptoms was higher in children after intervention,early diagnosis and treatment can relief clinical symptom early,but the change of imaging in most of the children was not obvious after treatment.