儿童重症腺病毒肺炎后遗留支气管扩张症26例临床分析

Clinical analysis of bronchiectasis in 26 children after severe adenovirus pneumonia

目的分析重症腺病毒肺炎后遗留支气管扩张症患儿的临床特征,为临床提供儿童重症腺病毒肺炎后遗留支气管扩张症的早期诊断线索。方法回顾性分析2016年5月至2021年5月广州医科大学附属广州市妇女儿童医疗中心诊治的重症腺病毒肺炎后遗留支气管扩张症患儿26例的临床资料。结果26例患儿中,男18例,女8例。重症腺病毒肺炎发病中位数年龄为23.0(15.0,48.0)个月,其中23例为混合感染,以混合细菌感染最常见(16例)。高分辨率CT示多肺叶肺实变伴/不伴胸腔积液。绝大部分病例急性期予以静脉注射用免疫球蛋白(21例)、机械通气(20例)、全身性糖皮质激素治疗(19例)。确诊支气管扩张症时,中位数年龄为29.5(21.0,56.8)个月,距腺病毒肺炎急性期的中位数时间为6.0(3.3,13.0)个月。6例单纯遗留支气管扩张;20例合并感染后闭塞性细支气管炎(PIBO),其中3例与PIBO同时出现支气管扩张,17例在PIBO后出现。以弥漫性支气管扩张为主(24例),最常累及左下叶(21例)和右下叶(21例),支气管扩张类型以柱状最常见(23例)。随访中均反复咳嗽、喘息,仅3例咳脓痰,无咯血。均出现急性加重,引起急性加重最常见病原为细菌(21例),19例合并PIBO及1例单纯支气管扩张症患儿需再次住院。无行外科手术切除或死亡病例。结论儿童重症腺病毒肺炎后遗留支气管扩张症多在PIBO基础上发生,也可单独发生。多肺叶累及与混合感染可能是PIBO基础上并发支气管扩张的高危因素。临床表现多为反复咳嗽、喘息,而咳痰及咯血较少见。临床医师应及时行胸部高分辨率CT早期诊断。

Objective To analyze the clinical features of bronchiectasis in children after severe adenovirus pneumonia and to provide clinical clues for the early diagnosis of bronchiectasis in children after severe adenovirus pneumonia.Methods A retrospective study was made to analyze the clinical data of 26 children with bronchiectasis after severe adenovirus pneumonia treated in Guangzhou Women and Children′s Medical Center,Guangzhou Medical University from May 2016 to May 2021.Results A total of 26 cases were reported,including 18 males and 8 females.The median onset age of severe adenovirus pneumonia was 23.0(15.0,48.0)months.A total of 23 cases suffered concurrent infections,and bacterial co-infection was the most common(16 cases).High resolution computed tomography(HRCT)showed multiple lobar solids in the lung with/without pleural effusion.During the acute phase,most of the cases were treated with intravenous immunoglobulin(21 cases),mechanical ventilation(20 cases),and systemic glucocorticoids(19 cases).The median age at diagnosis of bronchiectasis was 29.5(21.0,56.8)months,and the median time that the patients took to develop into acute adenovirus pneumonia was 6.0(3.3,13.0)months.Six cases suffered bronchiectasis alone,and 20 cases had bronchiectasis combined with post-infectious bronchiolitis obliterans(PIBO).Of these 20 cases,3 cases developed bronchiectasis and PIBO simultaneously,and the remaining 17 cases developed bronchiectasis after PIBO.In the included 26 cases,diffuse bronchiectasis predominated(24 cases),most frequently involving the left lower lobes(21 cases)and right lower lobes(21 cases).Cylindrical bronchiectasis was the most common type(23 cases).All the patients had recurrent cough and wheezing during follow-up,and only 3 cases coughed up pus sputum without hemoptysis.All children had acute exacerbations,which were mostly caused by bacteria(21 cases).Nineteen cases combined with PIBO and 1 case with only bronchiectasis were rehospitalized.There was no cases of surgical resection or death.Conclusions Bronchiectasis after severe adenovirus pneumonia mostly occurs in patients with or without PIBO.Multiple lobe involvement and co-infection may be a risk factor for PIBO patients to develop bronchiectasis.The clinical manifestations are mostly recurrent cough and wheezing,while sputum and hemoptysis are less common.Pediatricians should promptly perform chest HRCT for early diagnosis of the disease.