儿童重症腺病毒肺炎感染后发生闭塞性细支气管炎的危险因素分析  

The causes of bronchiolitis obliterans in children with severe adenovirus pneumonia

作　　者：黄葆莹[1] 蒋苏华[1] 梁永祺 陈晓倩[1] HUANG Bao-ying;JIANG Su-hua;LIANG Yong-qi;CHEN Xiao-qian(Department of Pediatrics,the First People's Hospital of Foshan,Foshan,Guangdong 528000,China)

机构地区：[1]佛山市第一人民医院儿科,广东佛山528000

出　　处：《热带医学杂志》2021年第6期770-773,共4页Journal of Tropical Medicine

基　　金：佛山市医学科技攻关项目(2018AB003201)。

摘　　要：目的探讨影响儿童重症腺病毒肺炎感染后闭塞性细支气管炎发生的危险因素,减少呼吸系统后遗症的产生。方法回顾性分析2018年1月至2019年10月佛山市第一人民医院儿童重症监护室收治的重症腺病毒肺炎出院患儿53例的临床资料,包括性别、年龄、基础病情况、ICU住院天数、呼吸机使用情况、呼吸机使用时间、腺病毒(HAdV)感染类型及治疗前实验室指标及随访结局等方面。结果随访3个月后共有45例患儿入选,其中22例(48.9%)发生闭塞性细支气管炎(PIBO组),23例未发生PIBO(非PIBO组)。PIBO组中HAdV-7型感染比例、呼吸机使用情况、呼吸机使用时间、ICU住院天数与非PIBO组比较差异有统计学意义(P均<0.05);PIBO组治疗前血清铁蛋白水平与非PIBO组比较,差异有统计学意义(P<0.05);两组患儿发病年龄、性别、基础病情况、混合细菌感染情况、淋巴细胞绝对值、血清IgE水平、白介素-6、D-二聚体、乳酸脱氢酶(LDH)、动脉血氧分压(PaO_(2))比较差异无统计学意义(P>0.05)。经Logistic多因素回归分析,呼吸机使用时间及血清铁蛋白水平为重症腺病毒肺炎发生PIBO的危险因素(OR=0.943,95%CI:0.8940.995;OR=1.006,95%CI:1.0001.011;P均<0.05)。结论儿童重症腺病毒肺炎感染后闭塞性细支气管炎比例高;呼吸机使用时间及血清铁蛋白水平测定对预后的预测有一定作用。Objective To analyze clinical characteristics of post-infectious bronchiolitis obliterans in children with severe adenovirus pneumonia(SAP),thereby provide a basic reference for reducing sequela. Methods From January 2018 to October 2019,clinical data of 53 cases with SAP admitted to the intensive care unit of the First People’s Hospital of Foshan were retrospectively analyzed. General conditions(age,gender),background diseases,length of ICU stay,usage of ventilation,length of ventilation type of human adenovirus(HAdV),evolution of blood tests and post-discharge respiratory outcomes were analyzed. Results 45 children with SAP were followed up for 3 months. 22/45(48.9%)occurred post-infectious bronchiolitis obliterans(PIBO). Patients were divided into PIBO group(n=22)and non-PIBO group(n=23).Percentage of type HAdV-7 infection,usage of ventilation,length of ventilation and length of ICU stay were significantly different in the two groups(P<0.05). Serum ferritin level was significantly different in the two groups(P<0.05). There were no significant differences in age,gender,background diseases,mixed infection,the lymphocyte value,serum IgE,interleukin(IL-6),D-dimer,lactate dehydrogenase(LDH)and PaO_(2) between two groups(P>0.05). Multivariate logistic regression analysis showed that length of ventilation and serum ferritin were risk factors for SAP developing into PIBO(OR=0.943,95%CI:0.894-0.995;OR=1.006,95%CI:1.000-1.011;both P<0.05). Conclusions Despite our cohort’s limited sample size,our findings suggested that a significant proportion of SAP survivors experienced PIBO. The length of ventilation and serum ferritin might beused for prediction of poor outcome.

关 键 词：重症腺病毒肺炎 感染后闭塞性细支气管炎 儿童 

分 类 号：R563.1[医药卫生—呼吸系统] R562.21[医药卫生—内科学]