摘要迁延性细菌性支气管炎是慢性湿咳超过4周,并且可被2～3个疗程的抗生素治愈的慢性下呼吸道感染性疾病.当各种因素损伤呼吸道上皮细胞后,由于免疫功能和黏膜清除功能紊乱,流感嗜血杆菌和肺炎链球菌等持续定植和中性粒细胞浸润导致发病.迁延性细菌性支气管炎的诊断主要依据:慢性湿性咳嗽超过4周,可伴有喘息,胸部X线片多正常,高分辨CT可以发现支气管壁增厚,纤维支气管镜可见支气管黏膜充血水肿、分泌物和痰栓,近1/3 ～2/3患儿合并喉、气管、支气管软化等气道畸形,支气管肺泡盥洗液培养阳性可确诊.经验治疗推荐使用阿莫西林克拉维酸钾2～3周,如果经过4个疗程抗生素治疗效果不佳者,需要重新寻找病因.积极治疗急性期细菌感染可预防迁延性细菌性支气管炎的发生,覆盖所有血清型的肺炎链球菌和流感嗜血杆菌疫苗的使用或许可以降低迁延性细菌性支气管炎的发病率.

abstractsProtracted bacterial bronchitis is Chronic lower respiratory infection,defined as chronic moist cough for more than 4 weeks and resolution of symptoms in the majority when antibiotic therapy is given for at least 2 to 3 weeks.After airway epithelial cells impaired by various factors,bacteria such as haemophilus influenzae and streptococcus pneumoniae colonizes on bronchial mucous membranes and leads to neutrophil infiltration.The diagnosis of protracted bacterial bronchitis is mainly based on chronic moist cough persisting for more than 4 weeks,sometimes accompanied by wheezing,with normal chest x-ray and bronchial wall thickened on high-resolution computed tomography,revealed redness and edema of the bronchial mucous membranes sometimes accompanied by tracheobronchomalacia as the main characteristic of bronchoscopy.The definite diagnosis can be made if the culture of bronchoalveolar lavage fluid is positive.If the majority of symptoms cannot be removed after 4-week therapy,the underline pathogenesis should be searched.Curing of of acute bacterial infection can prevent protracted bacterial bronchitis.New vaccines offering all serotype protection are needed to prevent protracted bacterial bronchitis caused by haemophilus infiuenzae and streptococcus pneumoniae.