儿童间质性肺疾病的临床研究

中图分类号 密级儿童间质性肺疾病的临床研究Clinical Study on Interstitial Lung Disease in Children计：学位论文： 35页表 格： 6个插 图： 4幅指导教师：黄燕教授申请学位级别：硕士学位培养单位：大连医科大学大连市儿童医院石伟学科(专业)：儿科学完成时间：二。一三年四月答辩委员会主席：独创性声明本人声明所呈交的学位论文是本人在导师指导下进行的研究工作及取得的研究成果。据我所知，除了文中特别加以标注和致谢的地方外，论文中不包含其他人已经发表或撰写过的研究成果，也不包含为获得大连医科大学或其他教育机构的学位或证书而使用过的材料。与我一同工作的同志对本研究所做的任何贡献均已在论文中作了明确的说明并表示谢意。学位论文作者签名：差蔓鱼签字日期： 业年三月工日关于学位论文使用授权的说明本学位论文作者完全了解学校有关保留、使用学位论文的规定，同意学校保留并向国家有关部门或机构送交论文的复印件和电子版，允许论文被查阅和借阅。本人授权大连医科大学可以将本学位论文的全部或部分内容编入有关数据库进行检索，可以采用影印、缩印或扫描等复制手段保存和汇编本学位论文。本学位论文属于(请在以下相应方框内打“4”)：1保密口，在 年解密后适用本授权书。2不保密函作者签名：屈编导师签名：Z毫日期：矽f弓年f月r7日日期：州年j肜日目 录一、摘要1(一)中文摘要l(二)英文摘要3二、正文00 O O OO O OO6(一)前言6(一)月lJ舌“一“”“”一”“”6(二)资料和方法61资料O O O O O O611 纳入标准612 排除标准713 临床诊断标准72方法721 病例收集方法722病原学检查方法723胸部CT检查方法824肺功能检查方法825 支气管镜检查方法926 结果判定标准927 主要试剂及仪器1 O28 统计学方法11(三)结果1 11 一般情况1 12 病因分布1 121总体病因分布1 122感染相关病因分布1 23 临床表现134 胸部CT征象145 肺功能变化156 支气管镜镜下特点1 5(四)讨论1 6(五)结论1 9(六)参考文献20三、综述22(一)综述22(二)参考文献28四、附录33五、致谢35大连医科大学硕士学位论文儿童间质性肺疾病的临床研究硕士研究生：石伟指导教师：黄燕教授指导小组：崔振泽教授专业名称：儿科学摘要目的分析儿童间质性肺疾病的临床表现、胸部CT征象、肺功能变化及支气管镜镜下特点，为儿童间质性肺疾病的诊断和治疗提供临床思路。方法采用回顾性分析的方法，选择2011年1月至2012年6月在大连市儿童医院呼吸病房住院，符合纳入标准、临床诊断间质性肺疾病的患者49例，总结分：析其临床表现、胸部CT征象、肺功能变化及支气管镜镜下特点，并将各项结果记录至病例登记表。结果1在49例儿童间质性肺疾病患者中，男性患者占755；2岁的患者占612；病因不明者占572，和感染相关者占367，和奶汁吸入相关者占61。2在49例儿童间质性肺疾病患者中，45例患者进行了血清病毒抗体测定，病毒抗体的阳性率为178；其中呼吸道合胞病毒感染者2例，腺病毒感染者5例，副流感病毒感染者1例。41例患者进行了肺炎支原体抗体测定，肺炎支原体抗体的阳性率为49。22例患者进行了支气管肺泡灌洗液细菌培养，灌洗液细菌培养的阳性率为364，其中肺炎链球菌感染者1例，流感嗜血杆菌感染者3例，大肠埃希菌感染者2例，鲍氏不动杆菌感染者2例。所有病原学检测阳性的患者均为单一病原体感染。3在49例儿童间质性肺疾病患者中，临床表现为咳嗽者占98O；活动后呼吸困难者占939；低至中等程度发热者占510。肺部听诊闻及湿哕音者占571；肺部听诊闻及喘鸣音者占531；肺部昕诊未见异常者占286。449例儿童间质性肺疾病患者均进行了胸部CT检查，胸部CT出现磨玻璃影者占939；出现网状阴影者占469；伴肺不张者占2O；伴胸膜增厚者占2O；伴实变影者占367；伴气肿者占82。大连医科大学硕士学位论文5，在49例儿童间质性肺疾病患者中，32例患者进行了肺功能检查，均表现不同程度的肺通气功能障碍；其中阻塞性通气功能障碍者占938；混合性通气功能障碍者占62。6在49例儿童间质性肺疾病患者中，22例患者进行了支气管镜检查，支气管镜镜下表现粘膜轻中度充血、肿胀，管嵴轻中度增宽，管口轻中度减小的患者占1 00；支气管镜镜下见黄白色粘稠分泌物、痰块样分泌物、坏死物者占864，奶汁样分泌物者占136。结论1儿童间质性肺疾病以男性患者为主，2岁以内好发，572的患者病因不明，367的患者病因和感染相关，61的患者病因和奶汁吸入相关。2儿童间质性肺疾病中90以上的患者出现咳嗽、活动后呼吸困难；50以上的患者肺部听诊可闻及湿哕音、喘鸣音。3儿童间质性肺疾病中90以上的患者胸部CT呈磨玻璃影，近12的患者呈网状阴影；约113的患者伴实变影。4儿童间质性肺疾病中90以上的患者肺功能表现为阻塞性通气功能障碍。5，儿童问质性肺疾病中100的患者支气管镜镜下表现粘膜轻中度充血、肿胀，管嵴轻中度增宽，管口轻中度减小；864的患者镜下可见黄自色粘稠分泌物、痰块样分泌物、坏死物；136的患者镜下可见奶汁样分泌物。关键词：间质性肺疾病 临床表现肺功能支气管镜镜下特点 儿童2大连医科大学硕士学位论文Clinical Study on Interstitial Lung Disease in ChildrenMaster degree candidate：Shi WeiSupervisor：Professor Huang YahVicesupervisor：Professor Cui ZhenzeMajor：PediatricsAbstractObjeetive 111e datum of interstitial lung disease in children were analyzed，including the clinical manifestations，the signs of chest CT,the changes of lung function，the finds of the bronchoscope，in order to provide clinical thought for diagnosis andtreatment on interstitial lung disease in childrenMethods The datum was analyzed retrospectively49 children diagnosedinterstitial lung disease in clinical were selected，who were hospitalized in therespiratory ward of Dalian childrenS hospital during the period from January 20 1 1 toJune 20 1 2，and met inclusion criteriaThe datum of interstitial lung disease in childrenwere summarized and analyzed，including clinical manifestations，the signs of cheSt CT,the changes of lung function，and the finds of the bronchoscopeThe results weredocumented in patient registration formsResults1In the 49 cases of interstitial lung disease in children，755of patients aremale6 12of patients are younger than 2 years oldInterstitial lung disease in childrenwas casued by unknown etiology,infection and inhalation，allocating 572，367and61respectively2In the 49 cases of interstitial lung disease in children，sera from 45 patients hadbeen tested for the presence of antibodies against the virus，and antibody positive ratewas 1 78Among them，respiratory syncytial virus infections were 2 cases，adenovirusinfections were 5 ones，influenza virus infection was 1 caseSera from 4 1 patients hadbeen tested for the presence of antibodies against mycoplasma pneumonia，and antibodypositive rate was 49Bronchoalveolar lavage fluid from 22 patients had been testedfor bacterial culture，and the positive rate was 364Among them，streptococcuspneumoniae infection was 1 case，haemophilus influenza infection were 3 ones，escherichia coli infection and acinetobacter baumannii infection were each 2 onesAUof patients，whose etiology detection result was positive，were simple infection3大连医科大学硕士学位论文3In the 49 cases of interstitial lung disease in children，98Oof patientscoughed，939ones had exercise intolerance，and 5 10ones got either low-grade ormoderate fever571of the chest auscultation had moist crackles531hadwheezing，286were basic normal4The 49 cases of interstitial lung disease in children were all performed chestCT SCanThe chest CT of 939patients showed ground-glass pattern，and 469showed reticular pattemThe signs accompanying atelectasis and accompanying pleuralthickening each accounted for 2OThe signs accompanying lung consolidationaccount for 367。and those accompanying emphysema accounting for 825In the 49 cases of interstitial lung disease in children，32 patients had lungfunction testsand showed lung ventilation dysfunction at different levels938ofpatients had obstructive ventilation dysfunction，and 62ones had combinedventilation dysfunction6 In the 49 cases of interstitial lung disease in children，22 patients wereselected for bronchoalveolar lavage22 patients all appeared mucosal hyperemia，swellingTheir tube crests had broaden and the diameter of tubular openings hadreducedThese performance were not seriousExcept three milky excretions whichaccounted for 1 36，the remaining were yellow-white viscous，Sputum，necroticmaterial，accounting for 867Conclusion1Interstitial lung disease in children is a predominantly male disease，moreprone to Occur within two-year-old childInterstitial lung disease in children wa