儿童塑型性支气管炎临床特征及复发危险因素分析

Clinical characteristics of plastic bronchitis and risk factors for recurrence in children

摘要:

目的 总结儿童塑型性支气管炎（plastic bronchitis，PB）的临床特征，探讨塑型物反复发生的危险因素。方法 回顾性分析2012年1月—2022年7月于重庆医科大学附属儿童医院住院治疗的PB患儿临床资料，根据塑型物发生次数分为单次PB组与复发性PB组，采用多因素logistic回归分析PB患儿塑型物反复发生的危险因素。结果 共纳入107例PB患儿，其中男性61例（57.0%），女性46例（43.0%），中位年龄5.0岁，3岁以上78例（72.9%）。所有患儿均有咳嗽。发热96例（89.7%），其中高热90例（84.1%）。气促73例（68.2%），呼吸衰竭64例（59.8%）。合并肺不张66例（61.7%），胸腔积液52例（48.6%）。肺炎支原体感染47例（43.9%），腺病毒感染28例（26.2%），流感病毒感染17例（15.9%）。71例（66.4%）发生1次塑型物，36例（33.6%）发生≥2次塑型物。多因素logistic回归分析显示镜下PB累及≥2个肺叶（OR=3.376）、首次取出塑型物后仍需有创通气（OR=3.275）、并发肺外多脏器功能损害（OR=2.906）为PB患儿塑型物反复发生的独立危险因素（P<0.05）。结论 对持续高热伴气促、呼吸衰竭及合并肺不张或胸腔积液的肺炎患儿，需高度警惕PB可能。支气管镜下PB累及≥2个肺叶、首次取出塑型物后仍需有创通气、并发肺外多脏器功能损害可能是PB患儿塑型物反复发生的危险因素。

Abstract:

Objective To study the clinical characteristics of plastic bronchitis (PB) in children and investigate the the risk factors for recurrence of PB.Methods This was a retrospective analysis of medical data of children with PB who were hospitalized in Children's Hospital of Chongqing Medical University from January 2012 to July 2022. The children were divided into a single occurrence of PB group and a recurrent PB group and the risk factors for recurrence of PB were analyzed.Results A total of 107 children with PB were included, including 61 males (57.0%) and 46 females (43.0%), with a median age of 5.0 years, and 78 cases (72.9%) were over 3 years old. All the children had cough, 96 children (89.7%) had fever, with high fever in 90 children. Seventy-three children (68.2%) had shortness of breath, and 64 children (59.8%) had respiratory failure. Sixty-six children (61.7%) had atelectasis and 52 children (48.6%) had pleural effusion. Forty-seven children (43.9%) had Mycoplasma pneumoniae infection, 28 children (26.2%) had adenovirus infection, and 17 children (15.9%) had influenza virus infection. Seventy-one children (66.4%) had a single occurrence of PB, and 36 cases (33.6%) had recurrent occurrence of PB (≥2 times). Multivariate logistic regression analysis showed that involvement of ≥2 lung lobes (OR=3.376) under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts (OR=3.275), and concomitant multi-organ dysfunction outside the lungs (OR=2.906) were independent risk factors for recurrent occurrence of PB (P<0.05).Conclusions Children with pneumonia accompanied by persistent high fever, shortness of breath, respiratory failure, atelectasis or pleural effusion should be highly suspected with PB. Involvement of ≥2 lung lobes under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts, and concomitant multi-organ dysfunction outside the lungs may be risk factors for recurrent occurrence of PB.