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新冠肺炎疫情前后儿童迁延性细菌性支气管炎诊疗进展
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Abstract:
迁延性细菌性支气管炎(PBB)是引起世界范围内儿童慢性湿咳的常见病因。PBB的发病与呼吸道内细菌感染、细菌生物被膜形成、气道中性粒细胞炎症等因素相关，既往对尘螨、牛奶蛋白过敏及湿疹史也是PBB相关危险因素。PBB的常见的病原菌包括流感嗜血杆菌、肺炎链球菌和卡他莫拉菌。PBB的诊断包括基于微生物和基于临床的两种诊断标准。多国临床指南推荐阿莫西林克拉维酸钾作为首选药物治疗至少2周。但目前对于抗生素治疗的最佳疗程尚不统一，适当延长抗生素疗程可能有助于降低PBB的复发率。PBB一般预后较好，但合并流感嗜血杆菌感染以及反复发作的PBB患儿，未来存在支气管扩张的风险。目前国内医师对PBB的认识存在不足，且新冠疫情对PBB的影响也不明确。本文对PBB的发病机制、临床表现以及新冠疫情前后感染病原体的变化进行综述。
Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in children worldwide. The onset of PBB is associated with factors such as bacterial infection in the respiratory tract, bacterial biofilm formation, and respiratory mucociliary clearance dysfunction. Past allergies to dust mites, milk protein, and eczema are also risk factors for PBB. Common pathogens of PBB include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. The diagnosis of PBB includes two diagnostic criteria based on microorganisms and clinical criteria. Clinical guidelines in many countries recommend amoxicillin and clavulanate potassium as the first choice for treatment for at least 2 weeks. However, there is currently no consensus on the optimal course of antibiotic treatment, and appropriately extending the course of antibiotic treatment may help reduce the recurrence rate of PBB. The prognosis of PBB is generally good, but children with PBB complicated with Haemophilus influenzae infection and recurrent episodes are at risk of bronchiectasis in the future. At present, domestic physicians have insufficient understanding of PBB, and the impact of the COVID-19 pandemic on PBB is also unclear. This article reviews the pathogenesis, clinical manifestations, and changes in infectious pathogens before and after the COVID-19 pandemic of PBB.
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