摘要
目的系统性研究儿童原发性纤毛运动障碍（primary ciliary dyskinesia，PCD）的临床特点，探讨PCD的诊断和鉴别诊断流程。方法对PCD患儿的临床资料进行分析。结果确诊PCD患儿26例，男11例，女15例。来自25个家族，1个家族诊断2例Kartagener综合征同胞姐弟。起病年龄为生后第2天～15岁，确诊时病程中位数为3．5年。所有患儿有咳嗽症状，24例有咯痰，7例有体格发育落后。23例接受支气管黏膜和（或）鼻黏膜的电镜检查，可见纤毛动力臂缺失6例，动力臂数目减少、微管排列紊乱、外周微管和（或）中央微管异常各4例，1例纤毛结构正常。经胸部CT证实，支气管扩张症8例，肺实变6例。20例存在鼻窦炎。15份痰或支气管肺泡灌洗液培养阳性标本中，铜绿假单胞菌8份，肺炎链球菌5份，白色念珠菌2份。其中1例培养出2种微生物。肺功能检查的16例中9例为阻塞性通气功能障碍。4例听力检测中3例异常，食管24hpH值测定的5例患儿中3例有胃食管反流。结论PCD起病年龄从新生儿期到青春期，呈慢性病程。主要临床表现为咳嗽、咯痰，可出现体格发育落后。PCD患儿中最多见的纤毛结构异常是动力臂缺失。部分患儿纤毛结构正常。影像学异常包括肺实变、支气管扩张症和鼻窦炎。常见的细菌病原为铜绿假单胞菌、肺炎链球菌，并可能存在混合感染。PCD患儿肺功能异常主要为阻塞性通气功能障碍，听力损害、胃食管反流出现率较高。
Objective Although primary ciliary dyskinesia （PCD） is a group of inherited diseases, accurate diagnosis and appropriate clinical care to prevent and treat the complications could maintain patients＇ quality of life and normal life span. The diagnosis of PCD may often be delayed because it is frequently misdiagnosed as bronchitis, sinusitis and otitis. This study aimed to analyze and summarize the clinical features of PCD and explore diagnostic and differential diagnostic procedures in children. Methods Patients were all chosen from the inpatient department of Beijing Children＇s Hospital, Capital Medical University between 1990-2006. The tunica mucosa bronchiorum and/or nasal mucous membrane were gained through bronchoscope in children suspected to have PCD. The ciliary ultrastructures were analyzed through the electron microscope. The clinical features and procedures of the diagnosis and differential diagnosis in children with PCD were analyzed. Results There were totally 26 children diagnosed as PCD with 10 （38.5%） Kartagener syndrome. All Kartagener syndrome children had mirror image dextrocardia with normal cardiac structure and situs inversus viscerum. The bronchoscopy performed in eight of 10 Kartagener syndrome children showed bronchus transposition. Twenty-six children came from twenty-five families. Although the siblings of four probands also had the symptoms of chronic cough with sputum, running nose and recurrent respiratory infections, only a boy and his sister were diagnosed as Kartagener syndrome simultaneously. Their parents and the other family members were healthy. Of the 26 patients, 11 were boys and 15 were girls. The median age at diagnosis was 8.7 years. The age of onset was between the second day after dilivery and fifteen years old, median age was 3 years. The course of disease before diagnosis was eleven days to twelve years （ median 3.5 years）. All the children had the symptom of cough, 24 of which bad productive cough. Seven cases were found to have clubbing fingers. Dynein arm defect was found in 10 children, 6 of them had total absence of dynein arms and 4 had decreased dynein arm numbers. Microtube derangements were found in 8 children. One Kartagener syndrome child bad a normal cilia structure.Bronchiectasis, consolidation and increased lung markings were found in 8, 6 and 7 patients separately on the radiographic study. Twenty patients had sinusitis. Nine of sixteen children had decreased PEF, FEV1 and/or FEF25-75 on the pulmonary function test. Fifteen culture samples obtained from 6 children＇s sputum and/or bronchoalveolar lavage fluid were positive for 8 strains of Pseudomonas aeruginosa, 5 strains of Streptococcus pneumoniae and 2 strains of Candicla albicans. In 1 subject more than one organism were found in the same sample. Hearing lost and gastroesophageal reflux were detected in 3 of 4 and 3 of 5 examined children respectively. Conclusions The onset of PCD can occur from neonate to adolescence and usually has a chronic course. The common symptom of pediatric PCD was productive cough and significant growth retardation. The most common ultrastructural abnormalities associated with PCD were the total absence of dynein arms,decreased dynein arm numbers and microtube derangement. Some patients have normal cilary structures. Bronchiectasis, consolidation and sinusitis were usually seen on the radiography. Pseudomonas aeruginosa and Streptococcus pneumoniae were the two common bacterial organisms obtained from sputum and/or bronchoalveolar lavage fluid of PCD children. Some patients have mixed infections. PCD children have high percentages of hearing lost and gastroesophageal reflux.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2008年第8期618-622,共5页
Chinese Journal of Pediatrics
