基于腺病毒肺炎1年随访闭塞性细支气管炎结局的巢式病例对照研究

Risk factors of bronchiolitis obliterans after adenovirus pneumonia:A nested case-control study

背景腺病毒肺炎患儿出院后的前瞻性随访研究较少,并且对于腺病毒肺炎发展为感染后闭塞性细支气气管炎(PIBO)的危险因素尚无有效预测指标。目的探讨腺病毒肺炎住院时指标对以后发生PIBO的预测价值。设计巢式病例对照研究。方法以2018至2019年出院诊断为腺病毒肺炎的儿童为队列人群,以出院1年中是否发生PIBO为结局终点,其中出院后2周来我院随访、3个月内行胸部影像学检查和12个月时或电话或来院随访是必需随访时点,其他随访由医生根据患儿病情做出安排。提取入院时的症状、体征、住院期间实验室指标、影像学检查结果、治疗情况。主要结局指标发生PIBO的危险因素。结果 102例完成1年的随访,期间51例有呼吸系统感染,13例因呼吸系统感染门诊就诊次数≥5次,6例因呼吸系统感染需要住院治疗;43例口服糖皮质激素治疗,35例吸入糖皮质激素治疗;29例(28.4%)诊断PIBO。对PIBO组和非PIBO组病例住院时的临床资料进行单因素分析发现,两组患儿平均年龄、过敏性鼻炎史、出现喘息、气促、三凹征阳性、哮鸣音、呼吸衰竭、平均乳酸脱氢酶浓度、合并病毒感染、合并≥2种病原体感染、受累肺叶≥3个、肺实变、肺不张、平均住院时间差异均有统计学意义(P均<0.05)。多因素Logistic回归分析发现,急性期有喘息表现(OR=3.110,P=0.045)及受累肺叶≥3个(OR=4.338,P=0.014)为发生PIBO的独立危险因素。结论腺病毒肺炎儿童出院后1年PIBO的发生率为28.4%,腺病毒肺炎患儿急性期有喘息表现及受累肺叶≥3个可能为PIBO发生的独立危险因素。

Background Prospective follow-up studies on children with adenovirus pneumonia after discharge are few,and there is no effective predictor of the risk factors for adenovirus pneumonia developing into post-infectious bronchiolitis obliterans(PIBO).Objective To investigate the predictive value of the indicators during hospitalization of adenovirus pneumonia for PIBO in the future.Design Nested case-control study.Methods Children discharged from hospital who were diagnosed as adenovirus pneumonia from 2018 to 2019 were selected as the cohort,and whether PIBO occurred within one year after discharge was the end point.We arrange them to come to our hospital for a follow-up 2 weeks after discharge.Within 3 months we will arrange them a chest imaging examination,and follow-up will be done by telephone or in the hospital at the 12th month after discharge.The time points mentioned above are essential and other follow-up arrangement will be based on the condition of children.The symptoms and physical signs at admission,results of laboratory examination and imaging examination and treatment during hospitalization will be extracted.Main outcome measures Risk factors for PIBO.Results A total of 102 patients were followed up for one year,of which 51 patients had respiratory infection,13 patients had more than 5 outpatient visits and 6 patients needed hospitalization due to respiratory infection,43 cases were treated with oral corticosteroids and 35 cases were treated with inhaled corticosteroids.Twenty-nine cases(28.4%)were diagnosed with PIBO.Univariate analysis of the clinical data of patients in PIBO group and non-PIBO group showed that there were significant differences(P<0.05)in average age,history of allergic rhinitis,wheezing,anhelation,retraction sign of three fossae,wheezing sound,respiratory failure,the average concentration of lactate dehydrogenase,virus infection,combining two or more kinds of pathogen infection,lung parenchyma infiltration≥3 lung lobes,lung consolidation,atelectasis,average length of hospital stay between the two groups.Multiple Logistic regression analysis showed that wheezing in the acute stage(OR=3.110,P=0.045)and more than 3 involved lung lobes(OR=4.338,P=0.014)were independent risk factors for PIBO.Conclusion The incidence of PIBO in children with adenovirus pneumonia within 1 year after discharge from hospital was 28.4%.Wheezing in the acute stage and more than 3 involved lung lobes were independent risk factors for PIBO in children with adenovirus pneumonia.