Yoon H M, Lee J S, Hwang J-Y, Cho Y A, Yoon H-K, Yu J, Hong S-J, Yoon C H
1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Br J Radiol. 2015 May;88(1049):20140478. doi: 10.1259/bjr.20140478. Epub 2015 Feb 24.
Intravenous pulse methylprednisolone therapy (IPMT) is an important treatment option for post-infectious obliterative bronchiolitis (OB), although it must be used carefully and only in selected patients because of its drawbacks. This study evaluated whether CT and clinical features of children with post-infectious OB can predict their responsiveness to IPMT.
We searched the medical records for patients (less than 18 years of age) who were diagnosed with post-infectious OB between January 2000 and December 2011. 17 children who received IPMT were included in this study. All underwent chest CT before and after IPMT. The radiological features seen on pre-treatment CT were recorded. The air-trapping area percentages on pre- and post-treatment CT images were determined. The nine patients who exhibited decreased air trapping on post-treatment CT scans relative to pre-treatment scans were classed as responders. The patient ages and time from initial pneumonia to IPMT were recorded.
All responders and only four non-responders had thickened bronchial walls before treatment (p = 0.029). The two groups did not differ significantly in terms of bronchiolitis, bronchiectasis or the extent of air trapping, although the responders had a significantly shorter median interval between initial pneumonia and IPMT (4 vs 50 months; p = 0.005) and were significantly younger (median, 2.0 vs 7.5 years; p = 0.048).
Immediate IPMT may improve the degree of air trapping in children with post-infectious OB if they show a thickened bronchial wall on CT.
Children with post-infectious OB may respond favourably to IPMT when pre-treatment CT indicates bronchial-wall thickening.
静脉注射脉冲甲基强的松龙疗法（IPMT）是感染后闭塞性细支气管炎（OB）的一种重要治疗选择，不过由于其缺点，必须谨慎使用，且仅适用于特定患者。本研究评估了感染后OB患儿的CT和临床特征是否能预测其对IPMT的反应。
我们检索了2000年1月至2011年12月期间诊断为感染后OB的患者（年龄小于18岁）的病历。本研究纳入了17名接受IPMT的儿童。所有患儿在IPMT前后均接受了胸部CT检查。记录治疗前CT上的影像学特征。确定治疗前和治疗后CT图像上的空气潴留面积百分比。将治疗后CT扫描显示空气潴留相对于治疗前扫描减少的9名患者归类为反应者。记录患者年龄以及从最初肺炎到接受IPMT的时间。
所有反应者以及仅4名无反应者在治疗前有支气管壁增厚（p = 0.029）。两组在细支气管炎、支气管扩张或空气潴留程度方面无显著差异，不过反应者从最初肺炎到IPMT的中位间隔时间显著更短（4个月对50个月；p = 0.005），且年龄显著更小（中位年龄，2.0岁对7.5岁；p = 0.048）。
如果感染后OB患儿在CT上显示支气管壁增厚，立即进行IPMT可能会改善空气潴留程度。
当治疗前CT显示支气管壁增厚时，感染后OB患儿可能对IPMT反应良好。
