儿童腺病毒肺炎后闭塞性细支气管炎的危险因素分析

Risk factors for bronchiolitis obliterans in children with adenovirus pneumonia

目的探讨儿童腺病毒肺炎后闭塞性细支气管炎的发生率以及相关危险因素。方法收集2012年1月至2017年12月在首都医科大学附属北京儿童医院诊断为腺病毒肺炎的206例患儿的临床资料及随访资料,根据恢复期是否发生闭塞性细支气管炎分为闭塞性细支气管炎组和非闭塞性细支气管炎组,并对相关因素进行logistic回归分析。结果47.57%(98/206)的腺病毒肺炎患儿在恢复期发生闭塞性细支气管炎。单因素分析发现,热程、急性期肺部喘鸣音、呼吸机使用时间、全身糖皮质激素开始使用时间、住院天数、既往喘息病史、急性期乳酸脱氢酶、发病年龄等8个指标两组间差异有显著性。多因素logistic回归分析显示有3个自变量纳入最佳回归方程,分别是呼吸机使用时间、既往喘息病史、急性期肺部喘鸣音,提示其为儿童腺病毒肺炎后闭塞性细支气管炎的独立危险因素。结论在腺病毒肺炎患儿恢复期闭塞性支气管炎的发生率较高,早期预测其后遗症的发生非常重要。急性期应用呼吸机时间、肺部闻及喘鸣音以及既往有喘息病史的患儿易发生闭塞性细支气管炎。

Objective To investigate the incidence and risk factors of bronchiolitis oblitians(BO)after adenovirus pneumonia in children.Method From Jan 2012 to Dec 2017,the clinical data of 206 cases with adenovirus pneumonia in Beijing Children’s Hospital were retrospectively analyzed.Follow-up all the cases,divided into two groups according to BO whether or not.Logistic regression analysis was performed to assess the risk factors for BO.Result 47.57%(98/206)of children with adenovirus pneumonia had developed to BO.Through the nivariate logistic regression analysis showed that fever processes,wheezing,respiratory support,the beginning time of the use of systemic glucocorticoid,hospitalization days,history of wheezing,LDH and age are risk factors for BO.Respiratory support,the history of breathing,wheezing are the independent risk factors.Conclusion The incidence rate of children with adenovirus pneumonia developing to BO is high,it’s very important to predict the possibility of BO in the early.The children with wheezing,respiratory support and the history of wheezing,is more likely to cause BO.