| Background:bronchiectasis is a chronic suppurative pulmonary disease,usually the final result of multiple pathophysiological processes such as recurrent respiratory tract infection and inflammatory response.It’s incidence has increased worldwide as HRCT is widely used in clinical practice.Bronchiectasis in children is always neglected for it’s early symptoms relative specificity and lighter as well as children itself won’t cough sputum,thus It affects the growth、quality of life and prognosis of children.Related studies show positive targeted therapy can improve the prognosis of bronchiectasis in children,but many pediatricians in our nation is confined to the diagnosis of "bronchiectasis" and pay less attention to find its reason.Meanwhile,most children with bronchiectasis also lack standardized treatment.Therefore,it is necessary to study the clinical features,pathogeny and prognosis of children with bronchiectasis.Objective:To retrospectively analyze the clinical features,auxiliary examination,complications,treatment and prognosis in patients with bronchiectasis.To find the difference among the three types of bronchiectasis.To increase the understanding of disease of bronchiectasis.Methods:61 patients with bronchiectasis confirmed by high-resolution computed tomography,who had been admitted to The Children’s hospital affiliated to the National Institute of Pediatrics from January 2007 to March 2018,were analized the patient’s age,gender,etiology,past history,clinical symptoms and signs,auxiliary examination data,complications,treatment and other clinical data.At the same time,to discuss the treatment status and prognosis after discharge,a telephone follow-up was conducted which was using a unified follow-up questionnaire.Results:1.General conditions:Average age of 61 patients(45.9%males and 54.1%females)were 98±45 months,the median history was 18 months.The average length of hospitalization was 8.3 ± 5.2 days.47.5%of the patients had a history of recurrent infection among which 44.8%were the recurrent respiratory infection.2.Etiology:The exact etiology was unidentified in 40.9%of patients.The common identified cause of bronchiectasis were infection(30.6%)、abnormal mucus removal(19.4%)and primary immunodeficiency(16.7%).About 90.1%of all the cases had current infection,while,whether the etiology was identified was not associated with current infection.3.Clinical manifestation:The main symptoms of bronchiectasis include cough(98.4%)and sputum(91.8%),and less common symptoms were chest tightness(6.5%),fatigue(4.5%)and chest pain(4.5%).Among sputum,mucous sputum is the most common(77.0%).The common signs of bronchiectasis were lung rale(49.2%)and clubbing(23.0%).Infection can aggravate or increase the manifestations.4.Imaging manifestations:Types of bronchiectasis in chest CT were cylindrical in 39.3%,varicose in 31.1%and cystic in 29.6%.Involvement was multilober in 80.3%,and bilateral involvement was common(68.9%).The most frequent involved lobes were right middle lobe(83.6%).5.Lung function:41 patients had pulmonary function test during in the hospital.Of 41 patients,16.4%displayed normal pulmonary function test result and 63.6%showed obstructive type.There were no difference in the pulmonary function among three types of bronchiectasis(P=0.435>0.05).6.Bronchoscopy:Of 61 patients,73.8%underwent bronchoscopy,with the most significant changes in bronchogenic changes(64.4%).There were 14 cases(31.1%)of biopsy results was recorded in there history and all of the recorded biopsy results were discribed as acute or chronic inflammatory cell infiltration.7.Etiology:In the 61 patients,91.8%had the sputum bacterial culture results,73.8%had alveolar lavage germiculture results as well as 93.4%took the determination of pathogen antibody of sputum immunofluorescence,The positive rates of the three above were 37.5%,62.2%and 49.1%respectively.Mycoplasma Pneumoniae was most common among patients with current infection(51.7%)and Pseudomonas Aeruginosa was the most common pathogenic bacteria in bacterial infected cases.8.Prognosis:41 of 61 patients(67.2%)were took Telephone follow-up and 85.4%of them were getting better after treatments.The patients with cylindrical bronchiectasis were likely to have higher clinical cure rate than patients with other kind of bronchiectasis(x ^2=1.692、P=0.032<0.05)Conclusion:1.The proportion of female patients with bronchiectasis in our hospital was higher than that of men,and most patients had a history of recurrent infection.2.In patients with bronchiectasis,the proportion of idiopathic bronchiectasis should not be overlooked,while,to the patients with clear etiology,the common etiology are the following three categories:infection,congenital immune deficiency and mucous removal.The vast majority of bronchiectasis patients are associated with present infection.3.The main clinical manifestations of hospitalized patients in our hospital are cough and sputum.The symptoms of cough,expectoration and wheezing are more obvious in patients with present infection.4.Chest CT manifestations of the patients in our hospital were mainly involved to multilober and the most frequent involved lobes were right middle lobe.5.Most of the patients with bronchiectasis have abnormal lung function,and the most common abnormal type is obstructive ventilation dysfunction.6.Bronchogenic changes in patients with bronchiectasis tend to be dominated by inflammatory changes,and the pathological examination is characterized by acute and chronic inflammatory cell infiltration.7.The most common infected pathogen of bronchiectasis patients is Mycoplasma Pneumoniae,and Pseudomonas Aeruginosa was commonly occurred pathogenic bacteria among bacterial infected cases.8.Most patients would be getting better after treatments,and the patients with cylindrical bronchiectasis are likely to have higher clinical cure rate than patients with other kind of bronchiectasis. |
