探讨儿童感染后闭塞性细支气管炎(PIBO)的临床特点。

选择2013年2月至2017年3月，于武汉儿童医院诊治的26例PIBO患儿为研究对象。回顾性分析其临床特点、病原学检查结果、影像学及肺功能检查结果、治疗和转归。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。

对纳入的26例PIBO患儿的研究结果如下。①主要临床表现：26例(100.0%)患儿表现为反复咳嗽及喘息，21例(80.8%)肺部闻及细湿啰音，14例(53.8%)合并活动后气促。②病原学检查结果：主要为腺病毒9例(34.6%)，肺炎支原体8例(30.8%)，麻疹病毒3例(11.5%)。③辅助检查结果：对26例患儿进行胸部高分辨率CT(HRCT)的检查结果显示，26例(100.0%)均为马赛克灌注征呈阳性，合并支气管扩张为2例(7.7%)，合并肺实变为13例(50.0%)，合并肺不张为7例(26.9%)；肺功能检查结果异常患者中，20例(76.9%)为阻塞性通气功能障碍，3例(11.5%)为混合性通气功能障；对11例患儿进行纤维支气管镜检查结果均显示支气管内膜炎症。④治疗与转归：对26例患儿均使用糖皮质激素及口服阿奇霉素治疗后，15例(57.7%)病情好转，11例(42.3%)临床症状反复或持续存在，本组无一例患儿死亡。

本组PIBO患儿表现为反复咳嗽、喘息，多为阻塞性通气功能障碍，胸部HRCT可见肺部特异性马赛克灌注征。腺病毒感染是该病患儿最常见病因。糖皮质激素和阿奇霉素治疗PIBO可能有效，本组PIBO患儿的总体预后欠佳。

To explore the clinical features of children with postinfectious bronchiolitis obliterans (PIBO).

A total of 26 children with PIBO from February 2013 to March 2017 in Wuhan Children′s Hospital were selected as research subjects. Clinical manifestation features, results of etiological examination, chest imaging examination and pulmonary function examination results, treatment and sequelae of them were retrospectively analyzed. The procedure followed in this study was consistent with World Medical Association Declaration of Helsinki revised in 2013.

The results of this study on 26 cases of PIBO were as follows. ① Main clinical manifestations: 26 cases (100.0%) with repeated cough and wheezing, 21 cases (80.8%) with crackles of lung, 14 cases (53.8%) combined with exertional dyspnea. ② Etiological examination results: main pathogens were adenovirus (9 cases, 34.6%), Mycoplasma pneumoniae (8 cases, 30.8%), measles virus (3 cases, 11.5%). ③ Auxiliary examination results: chest high resolution computed tomography (HRCT) of 26 cases of PIBO revealed that positive mosaic perfusion sign in 26 cases (100.0%), 2 cases (7.7%) combined with bronchiectasis, 13 cases (50.0%) combined with lung consolidation and 7 cases (26.9%) combined with atelectasis. Among cases with abnormal pulmonary function test results, there were obstructive ventilatory dysfunction in 20 cases (76.9%) and mixed ventilatory dysfunction in 3 cases (11.5%). Flexible bronchofiberscope examination was operated in 11 cases and all showed endobronchitis. ④ Treatment and sequelae: after applied glucocorticoids and azithromycin for all subjects, clinical manifestations in 15 cases (57.7%) were improved and clinical symptoms in other 11 cases (42.3%) were repeated or persistent, and there were no any deaths occurred.

Repeated cough and wheezing were main clinical manifestations of PIBO children in this study. Result of lung function mostly showed obstructive ventilatory dysfunction and chest HRCT examination revealed a typical mosaic perfusion signs. Adenovirus infection was the most common cause of PIBO children. Glucocorticoids and azithromycin may be effective for treatment of PIBO. The overall prognosis was poor in PIBO children in this study.