儿童肺炎后发生塑型性支气管炎的临床特征性表现及支气管镜诊治价值  

Clinical characteristics of plastic bronchitis after pneumonia in children and the value of bronchoscopy in diagnosis and treatment

作　　者：蔡利红[1,2] 李双双[2] 屈春燕[2] 严永东[1] 王美娟[1] 季伟[1] Cai Lihong;Li Shuangshuang;Qu Chunyan;Yan Yongdong;Wang Meijuan;Ji Wei(Department of Respiratory,Children's Hospital of Soochow University,Suzhou 215000,Jiangsu Province,China;Department of Pediatrics,Nantong Maternal and Child Health Hospital,Nantong 226015,Jiangsu Province,China)

机构地区：[1]苏州大学附属儿童医院呼吸科,215000 [2]南通市妇幼保健院儿科,226015

出　　处：《中华实用儿科临床杂志》2020年第21期1638-1642,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨儿童肺炎后发生塑型性支气管炎(PB)临床特征性表现及行电子支气管镜诊治的价值。方法以2017年6月至2019年5月在苏州大学附属儿童医院呼吸科住院治疗,使用过支气管镜进行诊治并符合支气管镜诊治标准的下呼吸道感染性疾病患儿为研究对象,共3865例。将患儿分成PB组、单纯痰栓堵塞组及无阻塞组[支气管镜下未见分泌物堵塞支气管腔,支气管肺泡灌洗液(BALF)中未见塑形分泌物的下呼吸道感染患儿],对其临床特征性表现、病原学及免疫功能、影像学等实验室检查结果进行比较分析。结果3组患儿性别分布差异无统计学意义(P=0.382)。PB组和单纯痰栓堵塞组的年龄均明显大于无堵塞组。3组患儿均有咳嗽。无堵塞组喘息患儿占25.06%(924/3687例)、单纯痰栓堵塞组占21.00%(21/100例),明显高于PB组的5.13%(4/78例)。PB组发热患儿比例最高占93.59%(73/78例),其次为单纯痰栓堵塞组,占83.00%(83/100例),无堵塞组占71.93%(2652/3687例),3组间比较差异有统计学意义(χ^2=23.571,P<0.05);PB组热峰(39.65±0.6)℃,热程(10.32±3.87)d;单纯痰栓堵塞组热峰(39.57±0.64)℃,热程(9.46±5.13)d;无堵塞组热峰(39.27±0.76)℃,热程(6.89±4.06)d。PB组患儿热峰高于无堵塞组、热程长于无堵塞组,差异均有统计学意义(均P<0.01)。3865例患儿行电子支气管镜检查前胸部影像学检查均有肺炎表现、大叶性肺炎及胸腔积液,3组占比第1位的是PB组[大叶性肺炎占79.49%(62/78例);胸腔积液占41.03%(32/78例)],其次是单纯痰栓堵塞组[大叶性肺炎占65%(65/100例),胸腔积液占27%(27/100例)]。PB组的C反应蛋白(CRP)、D-二聚体均明显高于单纯痰栓堵塞组,单纯痰栓堵塞组均明显高于无堵塞组。T淋巴细胞亚群中,CD4^+淋巴细胞比例PB组明显降低,CD8^+淋巴细胞比例PB组明显升高。3组患儿检出第1位的病原菌均为肺炎支原体(MP),但PB组MP检出率(84.62%,66/78例)明显高Objective To explore the clinical characteristics of plastic bronchitis(PB)in children after pneumonia and the value of electronic bronchoscopy in diagnosis and treatment of PB after pneumonia.Methods A total of 3865 children with lower respiratory infectious diseases who had been treated by bronchoscope and met the diagnosis and treatment criteria of bronchoscope in the Department of Respiratory,Children's Hospital Affiliated to Soochow University from June 2017 to May 2019 were studied.The children were divided into 3 groups,the PB group,the phlegm embolism blockage group,and the control group[including children with no secretion blocking the bronchial cavity under bronchoscope and no plastic secretion found in bronchoalveolar lavage fluid(BALF)].The results of laboratory examinations such as clinical characteristics,etiology,immune function and imaging were compared and analyzed.Results There was no significant difference in the gender distribution among the 3 groups(P=0.382).The average age of the PB group and phlegm embolism blockage group was significantly older than that of the control group.All the 3 groups had cough.The proportions of coughing children with asthma in the control group and phlegm embolism blockage group[25.06%(924/3687 cases)and 21.00%(21/100 cases),respectively]were significantly larger than that in the PB group[5.13%(4/78 cases)].The PB group had the highest ratio of children with fever[93.59%(73/78 cases)],followed by the phlegm embolism blockage group[83.00%(83/100 cases)]and the control group[71.93%(2652/3687 cases)]successively.The difference among the 3 groups was significant(χ^2=23.571,P<0.05).The fever peaks of the PB group,phlegm embolism blockage group and control group were(39.65±0.6)℃,(39.57±0.64)℃ and(39.27±0.76)℃,respectively;the fever duration of the above 3 groups were(10.32±3.87)days,(9.46±5.13)days and(6.89±4.06)days,respectively.The PB group had a higher fever peak and longer fever duration than the control group(all P<0.01).Before the electronic bronchosc

关 键 词：电子支气管镜 塑型性支气管炎 D-二聚体 C反应蛋白 儿童 

分 类 号：R725.6[医药卫生—儿科]