| Background:The pathogenesis of bronchiolitis obliterans(BO)is still unclear,and it is generally believed that BO is an irreversible injury mediated by inflammatory and immune factors.BO is often secondary to severe lung injury,in which infection is the primary factor.The clinical manifestations are not specific,and the overall prognosis is not good.How to evaluate the disease development in the early stage and prevent and block lung injury in advance is the key to improve the prognosis of BO.Objective:To understand the clinical characteristics and prognosis of children with postinfectious bronchiolitis obliteratus(PIBO),and to explore the high-risk factors of PIBO,so as to provide scientific basis for early diagnosis,early intervention and improvement of prognosis..Methods:A retrospective analysis was performed on the clinical data of 75 children diagnosed with PIBO in the respiratory medicine ward of our hospital from January 2015 to July 2018,and 28 children with previous adenovirus pneumonia without PIBO.The age,gender,pathogen,clinical symptoms and signs,chest high-resolution CT,lung function,fiberoptic bronchoscopy,treatment and prognosis of PIBO were analyzed,and the clinical data of children with adenovirus pneumonia-related PIBO and those without PIBO were compared.Results:1.Among the 75 cases diagnosed with PIBO,49 cases(65.3%)were males and 26 cases(34.6%)were females.In terms of age distribution,the average age was 25.8±1.8months,accounting for 74.7%in 56 cases less than 3 years old,and 25.3%in 19 cases more than 3 years old.2.All the 75 children diagnosed with PIBO had a clear history of severe pneumonia,among which 28(37.3%)were infected with adenovirus.Mycoplasma pneumoniae infection in 9 cases(12%);Seven cases(9.3%)were infected by bacteria.Four cases(5.3%)were infected with cytomegalovirus.Measles virus infection in 2 cases(2.7%);The pathogen was unknown in 25 cases(33.3%).The mean time from primary lung injury to the diagnosis of PIBO was 2.1±0.6 months.The mean time to diagnose PIBO after adenovirus infection was 1.7±0.3 months,and the mean time to diagnose PIBO after mycoplasma pneumoniae infection was 3.2±0.6 months.3.HRCT in the lungs of 75 children diagnosed with PIBO showed small airway lesions,and Mosaic perfusion was found in more than half of the cases.70 cases of pulmonary function and bronchodiastolic test were found to have obstructive ventilation dysfunction,and the bronchodiastolic test was negative.Fiberoptic bronchoscopy was performed in 73 cases,and the results all indicated bronchitis.4.All the 75 children were hospitalized with hypoxemia and were treated with inhaled corticosteroids combined with bronchiectasis aerosol inhalation and anti-infection antibiotics.Respiratory symptoms were improved at 4.7±0.6 days(median 5 days)after admission,and were discharged at 7.8±1.5 days(median 9 days).Montelukast and atomization therapy were given at discharge.A total of 42 patients were interviewed by telephone and clinic.All children had recurrent cough and wheezing of varying degrees after discharge,and 12 of them recovered well(28.6%).Thirty patients had a history of rehospitalization(71.4%).Among the 37 children who received regular reexamination in the outpatient department of respiratory medicine in our hospital,15(40.0%)showed slight improvement in pulmonary CT,and 22(60%)showed no improvement or aggravation.5.Among the 28 cases of adenovirus pneumonia-related PIBO,19 cases(67.8%)had used mechanical ventilation during the acute phase of infection.Among the other 28 cases of synchronous adenovirus pneumonia without PIBO,only 3 cases(10.7%)used mechanical ventilation in the acute phase of infection,showing statistically significant difference.Conclusion:1.Children with PIBO are more likely to be younger than 3 years old.2.Adenovirus is the first pathogen causing PIBO in children,and the average diagnosis time of PIBO was 1.7 months.3.Mechanical ventilation may be associated with adenovirus-induced PIBO. |
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