| Background:Bronchiolitis obliterans (BO) is a clinical syndrome that is characterized by chronic airflow obstruction related to bronchiolitis. At present, BO is a pathological diagnosis, which means bronchiole and alveolar duct obstructed partially or completely, epithelial regeneration and scar induced by airway epithelium injury. BO can be divided into two categories:constrictive bronchiolitis and proliferating of bronchioltis.The etiology of BO is various. Anything that can cause damage, inflammation of bronchiolar epithelial cells and epithelial, can lead to BO.BO in children is mainly caused by infection (post-infectious bronchiolitis obliterans, PIBO). The infection could be adenovirus, influenza virus, measles virus, mycoplasma pneumonia, etc.Although pathology is the gold standard of BO, it is very difficult to get lung biopsy in pediatrics. It is hard for the parents to accept this technology. So, the diagnosis of BO depends more and more on HRCT recently. Due to the irreversible BO lesions, most children have poor prognosis. It bring mental and economic burden to families with these children. Aim:To provide the basis for the intervention and prognosis of PIBO in clinic.Methods:Thirty-nine cases with PIBO were admitted to Children’s Hospital Zhejiang University Medical School from Jul2009to Dec2012. Their clinical information was collected. Samples including blood or sputum or bronchoalveolar lavage fluid were used to test etiology, T cell subsets, cytokines, IgG, IgA,IgM and IgE. Fiberoptic bronchoscopy was used to differentiate diagnosis and treatment in some of them. Follow-up of all cases was conducted by telephone.Results:39cases (male28cases, female11cases), the mean age is22.9months. They all had repeated cough and wheeze which continued for1month to2years.18(46.2%) had a history of severe pneumonia. Among them there were7(38.9%) cases with mycoplasma pneumonia infection,4(22.2%) cases with chlamydia pneumonia infection,1case with measles virus infection,1case with respiratory syncytial virus (RSV) infection,1case with parainfluenza virus Ⅲ infection. All children detected the pathogen.24cases were positive (61.5%). Among them,9cases were infected with mycoplasma pneumonia,6cases with chlamydia pneumonia,3cases with parainfluenza virus Ⅲ,2cases with RSV,2cases with metapneumovirus.29children took the fiberoptic bronchoscopy. The results were all bronchitis. BALF cell counts showed increased neutrophil (100%), increased eosinophil (40.9%). Peripheral blood CD4+T cells decreased (73.7%), CD8+T cells increased (73.7%), CD4/CD8decreased (68.4%).30children tested allergen,21cases were negative (70%),9cases were positive (30%).10children tested cytokines (IL-6, IL-10, TNF-α),6 cases were normal (60%).34children took HRCT, showingpulmonary emphysema,mosaic infusions,ect.15children had pulmonary function test. All showed airway obstructive obstruction. Bronchial dilation testwas negative (100%). All39cases were followed up by telephone.22cases were succeeded (56.4%). The follow-up time was4months to3years.22children continued the treatment of budesonide with or without bronchodilators inhilation.5of them took the nebulization everyday (QD or BID),17of them took the nebulization when they had cough or wheeze.4children got better (18.2%),18children still had recurrent cough and wheeze. HRCT was checked again in3children. There was no improvement in HRCT.Conclusions:Severe pneumonia is a common cause of BO in children. Mycoplasma pneumonia, adenovirus are the most common infection. Airway neutrophil inflammation and CD4+/CD8+T subsets imbalance may be involved in the pathogenesis. Long-term budesonide nebulization did not improve the prognosis in children with PIBO. |
PDF Full Text Request