闭塞性支气管炎的研究进展

Research Progress in Obliterative Bronchitis

摘要: 闭塞性支气管炎是一种临床少见的慢性阻塞性肺部疾病，主要为感染导致，病原主要为肺炎支原体、腺病毒，主要病理改变为支气管闭塞、急慢性气道炎症，目前发病机制尚不明确。闭塞性支气管炎的主要临床表现为慢性咳嗽、喘息、气促、活动不耐受，体征常可见三凹征、呼吸音减弱等，严重者有胸部塌陷、气管移位，影像学上常伴有肺部实变、不张、胸腔积液等。支气管镜下可见支气管闭塞及气道炎症，可合并支气管狭窄或扩张。目前对于闭塞性支气管炎的治疗方案尚不明确，主要以内科保守治疗为主，主要治疗手段包括抗感染、抗炎治疗、支气管镜灌洗及介入治疗，内科保守治疗无效时可考虑手术治疗。此疾病预后多数较好，部分患儿临床表现较轻，部分患儿经保守治疗后肺部可自行复张，但亦有治疗效果不佳、临床表现严重、甚至死亡的案例。本文就儿童闭塞性支气管炎目前的研究进展作一综述。

Abstract: Occlusive bronchitis is a rare clinical chronic obstructive pulmonary disease, which is mainly caused by infection. The main pathogens are mycoplasma pneumoniae and adenovirus, and the main pathological changes are bronchial occlusion and acute and chronic airway inflammation. The pathogenesis is still unclear. The main clinical manifestations of bronchitis obliterans are chronic cough, wheezing, shortness of breath, and activity intolerance, and the signs are often seen as triscufofoal sign and decreased breathing sound, etc. In severe cases, chest collapse and tracheal displacement are often accompanied by lung consolidation, atelectasis, pleural effusion, etc. Bron-choscopy shows bronchial occlusion and airway inflammation, which may be combined with bron-chial stenosis or dilatation. At present, the treatment plan for bronchiolitis oblitans is not clear, and the main treatment methods are mainly internal conservative treatment, including anti-infection, anti-inflammatory therapy, bronchoscopic lavage and interventional therapy. If internal conserva-tive treatment fails, surgical treatment can be considered. Most of the patients with this disease have a good prognosis; some of them have mild clinical manifestations; some of them can sponta-neously re-expand their lungs after conservative treatment; but there are also cases of poor treat-ment effect, serious clinical manifestations, and even death. This article reviews the research pro-gress of pediatric bronchiolitis obliterans.