儿童腺病毒感染后闭塞性细支气管炎的临床特征及预后影响因素分析

Clinical characteristics of and prognostic factors for bronchiolitis obliterans after adenovirus infection in children

摘要:

目的 探讨儿童腺病毒感染后闭塞性细支气管炎的临床特征及预后影响因素。方法 选取2020年1月—2022年2月在长江大学附属荆州医院治疗的腺病毒感染肺炎后闭塞性细支气管炎（BO）患儿60例（观察组），另取同期该院腺病毒感染肺炎后未发生BO患儿60例（对照组），比较观察组与对照组临床特征、高分辨率CT，分析腺病毒感染肺炎后BO患儿预后不良的影响因素。结果 观察组患儿年龄< 3岁、热程≥ 7 d、热峰≥ 40 ℃、喘息、气促、低氧血症、机械通气、有马赛克灌注征象、支气管扩张、支气管壁增厚及受累> 3叶的构成比高于对照组（P <0.05）。观察组预后不良患儿年龄< 3岁、有低氧血症和受累> 3叶的构成比高于预后良好患儿（P <0.05）。多因素一般Logistic回归分析结果显示，年龄≥3岁［O^R=0.505（95% CI：0.350，0.728）］、低氧血症［O^R=2.779（95% CI：1.505，5.132）］、受累> 3叶［O^R=4.540（95% CI：2.061，10.003）］是腺病毒感染肺炎后BO患儿预后不良的影响因素（P <0.05）。结论 腺病毒感染后BO患儿年龄较小，临床症状较重，其预后受年龄、低氧血症及肺叶受累情况的影响。

Abstract:

Objective To investigate the clinical characteristics of and prognostic factors for bronchiolitis obliterans after adenovirus infection in children.Methods Sixty children with bronchiolitis obliterans (BO) after adenovirus pneumonia treated in our hospital from January 2020 to February 2022 were selected (observation group), and another 60 children without BO after adenovirus pneumonia in our hospital during the same period were also included (control group). The clinical features and findings on high-resolution computed tomography (HRCT) were compared between the observation group and the control group. The factors contributing to poor prognosis of children with BO after adenovirus pneumonia were analyzed.Results The proportions of children with age < 3 years, duration of fever ≥ 7 days, peak of fever ≥ 40 ℃, wheezing, shortness of breath, hypoxemia, mechanical ventilation, mosaic perfusion signs, bronchiectasis, bronchial wall thickening and > 3 pulmonary lobes involved in the observation group were significantly higher than those in the control group (P < 0.05). The proportions of children with age < 3 years, hypoxemia and >3 pulmonary lobes involved were higher in those with poor prognosis than in those with good prognosis among the observation group (P < 0.05). Multivariable Logistic regression analysis demonstrated that young age [O^R = 0.505 (95% CI: 0.350, 0.728) ], hypoxemia [O^R = 2.779 (95% CI: 1.505, 5.132) ] and > 3 pulmonary lobes involved [O^R = 4.540 (95% CI: 2.061, 10.003) ] were factors contributing to poor prognosis of children with BO after adenovirus pneumonia (P < 0.05).Conclusions The children with BO after adenovirus infection are younger and have severer clinical symptoms, and their prognosis may be affected by age, hypoxemia and pulmonary lobe involvement.