重症肺炎后闭塞性细支气管炎的危险因素分析

Analysis of Risk Factors for Obliterative Bronchiolitis Caused by Severe Pneumonia

目的探讨引起感染后闭塞性细支气管炎(postinfectious bronchiolitis obliterans,PIBO)的重症肺炎的临床特征及危险因素。方法回顾性分析2014年4月—2019年4月在深圳市儿童医院因重症肺炎住院治疗并最终诊断为PIBO的病例为观察组,并随机抽取同期诊断为重症肺炎未发生PIBO的病例为对照组。分析观察组重症肺炎的临床特征,并分析发生PIBO的危险因素。结果观察组49例,对照组98例。观察组男33例,女16例;发病年龄≤2岁45例(91.8%),患者发热、咳嗽49例(100%),热程(12.898±5.818)d,喘息22例(44.9%)、气促19例(38.8%)。出院时肺部仍有啰音28例(57.1%)。胸部影像病初表现为间质性改变11例(78.6%,11/14),病程中主要表现为实变19例(57.6%,19/33)。病原腺病毒26例(53.1%),肺炎支原体17例(34.7%)。入住PICU 31例(63.3%),使用有创呼吸机19例(38.8%),使用激素25例(51.0%),使用人免疫球蛋白28例(57.1%)。多因素Logistic回归结果显示,性别男(OR=2.842,95%CI:1.122~7.195)、发病年龄≤2岁(OR=4.627,95%CI=1.588~13.485)、出院时肺部啰音(OR=3.457,95%CI=1.386~8.621)、使用有创呼吸机(OR=3.865,95%CI=1.320~11.317)、合并腺病毒(OR=2.750,95%CI=1.139~6.639)是发生PIBO独立危险因素(P<0.05)。结论发病年龄≤2岁、男性儿童发生腺病毒重症肺炎时,如肺部啰音吸收较慢,肺部影像从间质改变转为实变,尤其需要有创机械通气时,应警惕PIBO可能。

Objective To investigate the clinical features and risk factors of severe pneumonia caused by post-infectious bronchiolitis obliterans(PIBO).Methods A retrospective analysis of the patients who were hospitalized for severe pneumonia in Shenzhen Children's Hospital from April 2014 to April 2019 and the final diagnosis of PIBO was PIBO group,and randomly selected concurrent diagnosis of severe pneumonia did not occur PIBO as a control group.The clinical features of severe pneumonia in the PIBO group were analyzed and the risk factors for PIBO were analyzed.Results There were 49 patients in the PIBO group and 98 patients in the control group.In the PIBO group,33 males and 16 females;onset age≤2 years old 45 patients(91.8%),patients with fever,cough in 49 cases(100%),heat history(12.898±5.818)days,wheezing 22 cases(44.9%),gas Promoted 19 cases(38.8%).There were still 28 cases(57.1%)of voices in the lungs at the time of discharge.The chest image showed an interstitial changes in 11 cases(78.6%,11/14),and the main manifestation were consolidation in 19 cases(57.6%,19/33).Pathogenic adenovirus was found in 26 cases(53.1%)and mycoplasma pneumoniae in 17 cases(34.7%).31 patients(63.3%)were enrolled in PICU,19(38.8%)were treated with invasive ventilator,25(51.0%)were treated with the hormone,and 28(57.1%)were treated with gamma globulin.Multivariate logistic regression showed that males(OR=2.842,95%CI=1.122-7.195),onset age≤2 years(OR=4.627,95%CI=1.588-13.485),and had a voice in the lungs at discharge(OR=3.457,95%CI=1.386-8.621),invasive ventilator(OR=3.865,95%CI=1.320-11.317),adenovirus infection(OR=2.750,95%CI=1.139-6.639)and PIBO independence risk Factors(P<0.05).Conclusion The age of onset≤2 years old,male children with severe pneumonia caused by adenovirus,if slow absorption of lung sounds,lung image changes from interstitial to solid,especially invasive mechanical ventilation,should be alert to PIBO.