摘要
目的探讨腺病毒肺炎后闭塞性细支气管炎(BO)的临床特点及其危险因素。方法选择2011年1月至2017年12月苏州大学附属儿童医院呼吸科住院的腺病毒肺炎患儿,按是否发展为BO分为BO组与非BO组,收集临床资料进行回顾性分析,采用t检验、秩和检验或χ2检验进行组间比较,危险因素分析采用二元Logistic回归分析。结果纳入的腺病毒肺炎住院患儿共266例,发展为BO的患儿37例(13.9%)。BO组年龄小于非BO组,差异有统计学意义[12.0(8.0,17.5)月龄比32.0(13.0,48.0)月龄,P<0.001];BO组早产儿比例[10.8%(4/37例)比3.1%(7/229例),P=0.028]、有基础疾病的比例[21.6%(8/37例)比4.4%(10/229例),P<0.001]、有过敏性疾病的比例[35.1%(13/37例)比20.1%(46/229例),P=0.041]高于非BO组,差异均有统计学意义。BO组热程较非BO组长[10(4.0,13.5)d比6(4.0,9.0)d,P=0.011],差异有统计学意义;BO组出现喘息、气促、低氧血症症状患儿多于非BO组[81.1%(30/37例)比27.9%(64/229例),P<0.001;64.9%(24/37例)比5.7%(13/229例),P<0.001;59.5%(22/37例)比6.6%(15/229例),P<0.001],差异均有统计学意义。BO组外周血血小板计数、免疫球蛋白G水平、CD3^-CD19^+淋巴百分比高于非BO组[(364±104)×10^9/L比(297±105)×10^9/L,P=0.001;6.74(4.92,10.16)g/L比5.93(1.00,8.04)g/L,P=0.016;(33.5±15.3)%比(26.1±10.2)%,P=0.008],差异均有统计学意义;BO组CD3+CD4+淋巴细胞百分比低于非BO组[(29.1±8.0)%比(32.5±9.4)%,P=0.044],差异有统计学意义。BO组混合细菌感染比例高于非BO组[37.8%(14/37)比16.6%(38/229),P=0.003],差异有统计学意义。年龄<26个月、合并基础疾病、早产史、病程中出现喘息、气促、低氧血症为腺病毒肺炎后BO发生的独立危险因素(OR=4.808、30.667、7.558、3.909、8.842、8.607,均P<0.05)。结论年龄<26个月、有早产史、合并基础疾病、表现为喘息、气促及低氧血症是腺病毒肺炎后BO的独立危险因素,当临床上患儿符合上述表现时,需尽早行高分辨CT明确是否发生BO。
Objective To investigate the clinical characteristics and risk factors of bronchiolitis obliterans(BO)after adenovirus pneumonia.Methods Clinical data of 266 children with adenovirus pneumonia hospitalized in Children′s Hospital of Soochow University from January 2011 to December 2017 were retrospectively analyzed.Accor-ding to whether they developed BO,children with adenovirus pneumonia were divided into the BO group and the non-BO group.Clinical features of the BO group and the non-BO group were compared by t test,rank sum test or chi square test.Risk factors were analyzed by Logistic regression approach.Results Among 266 children with adenovirus pneumonia included,37 patients were developed into BO group,and their age was significantly younger than that of the non-BO group[12.0(8.0,17.5)months vs.32.0(13.0,48.0)months,P<0.001].Compared with the non-BO group,there were more proportion of preterm infants[10.8%(4/37 cases)vs.3.1%(7/229 cases),P=0.028],more instances of comorbidities[21.6%(8/37 cases)vs.4.4%(10/229),P<0.001]and more children with allergic diseas[35.1%(13/37 cases)vs.20.1%(46/229 cases),P=0.041]in the BO group,and the difference was statistically significant.The duration of fever in the BO group was significantly longer than that of the non-BO group[10(4.0,13.5)d vs.6(4.0,9.0)d,P=0.011]children with symptoms of wheezing,shortness of breath,and hypoxemia in the BO group were significantly more than the non-BO group[81.1%(30/37 cases)vs.27.9%(64/229 cases),P<0.001;64.9%(24/37 cases)vs.5.7%(13/229 cases),P<0.001;59.5%(22/37 cases)vs.6.6%(15/229 cases),P<0.001].The platelet count,IgG level,and CD3-CD19+lymphocyte percentage were significantly higher in the BO group than the non-BO group[(364±104)×10^9/L vs.(297±105)×10^9/L,P=0.001;6.74(4.92,10.16)g/L vs.5.93(1.00,8.04)g/L,P=0.016;(33.5±15.3)%vs.(26.1±10.2)%,P=0.008].In contrast,the percentage of CD3+CD4+lymphocytes in the BO group was lower than the non-BO group[(29.1±8.0)%vs.(32.5±9.4)%,P=0.044],the difference was statistically significant.The BO group had a higher rate of mixed bacterial infection than the non-BO groups[37.8%(14/37 cases)vs.16.6%(38/229 cases),P=0.003].An age<26 months,comorbidities,premature birth history,wheezing,shortness of breath,and hypoxemia were independent risk factors for BO after adenovirus pneumonia(OR=4.808,30.667,7.558,3.909,8.842,8.607,all P<0.05).Conclusions An age of less than 26 months,a history of premature delivery comorbidities,wheezing,shortness of breath and hypoxemia,are independent risk factors for BO after adenovirus pneumonia.Children with above manifestations should receive high resolution CT as soon as possible to determine whether it is BO.
作者
戴鸽
王婷
蒋吴君
孙慧明
王美娟
陈正荣
黄莉
季伟
郝创利
王宇清
严永东
Dai Ge;Wang Ting;Jiang Wujun;Sun Huiming;Wang Meijuan;Chen Zhengrong;Huang Li;Ji Wei;Hao Chuangli;Wang Yuqing;Yan Yongdong(Department of Respiratory,Children′s Hospital of Soochow University,Suzhou 215003,Jiangsu Province,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2020年第16期1235-1238,共4页
Chinese Journal of Applied Clinical Pediatrics
作者简介
通信作者:严永东,Email:yan_yong_dong@163.com。
