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儿童流感合并塑型支气管炎的临床特征分析
Clinical features of influenza with plastic bronchitis in children
目的 分析儿童流感合并塑形支气管炎（PB）的临床特征，提高对流感病毒所致PB的诊治认识。方法 选取2018年10月至2019年10月发生下呼吸道流感病毒感染患儿70例为研究对象，按照是否合并PB分为流感合并PB组（n=12）和流感未合并PB组（n=58）。收集并记录两组患儿的一般资料、临床表现、实验室检查、影像学表现、治疗及预后，进行回顾性分析。结果 流感合并PB患儿中，1~5岁为高发年龄；1月、2月、7月、9月为高发季节；以发热、咳嗽、气促为主要表现；流感合并PB组患儿气促、过敏性疾病（哮喘等）发生率高于流感未合并PB组（P < 0.05） ；12例患儿中，甲型流感病毒感染7例（58%），乙型流感病毒感染5例（42%），其中1例存在肾病综合征基础疾病；流感合并PB组患儿影像学以肺部实变伴不张、模糊高密度浸润影、胸腔积液和纵膈气肿为主要表现。流感合并PB组患儿入住PICU率较流感未合并PB组显著升高（P < 0.05）；入院1周内行支气管镜灌洗术，予以抗感染和对症支持治疗，均好转出院。结论 流感合并PB起病急、进展快，尽早行支气管镜检查十分重要。流感患儿表现出气促及存在哮喘等过敏性疾病或肾病综合征基础疾病，应警惕PB的发生。
Objective To study the clinical features of influenza with plastic bronchitis (PB) in children, and to improve the awareness of the diagnosis and treatment of PB caused by influenza virus. Methods A retrospective analysis was performed for the clinical data of 70 children with lower respiratory influenza virus infection from October 2018 to October 2019. According to the presence or absence of PB, they were divided into an influenza+PB group with 12 children and a non-PB influenza group with 58 children. Related clinical data were collected for the retrospective analysis, including general information, clinical manifestations, laboratory examination, imaging findings, treatment, and prognosis. Results In the influenza+PB group, most children experienced disease onset at the age of 1-5 years, with the peak months of January, February, July, and September. Major clinical manifestations in the influenza+PB group included fever, cough, and shortness of breath. The influenza+PB group had significantly higher incidence rates of shortness of breath and allergic diseases such as asthma than the non-PB influenza group (P < 0.05). Of the 12 children in the influenza+PB group, 7(58%) had influenza A virus infection and 5 (42%) had influenza B virus infection, among whom 1 had nephrotic syndrome. For the children in the influenza+PB group, major imaging findings included pulmonary consolidation with atelectasis, high-density infiltration, pleural effusion, and mediastinal emphysema. Compared with the non-PB influenza group, the influenza+PB group had a significantly higher proportion of children who were admitted to the pediatric intensive care unit (P < 0.05). Bronchoscopic lavage was performed within 1 week after admission, and all children were improved and discharged after anti-infective therapy and symptomatic/supportive treatment. Conclusions Influenza with PB tends to have acute onset and rapid progression, and it is important to perform bronchoscopy as early as possible. The possibility of PB should be considered when the presence of shortness of breath, allergic diseases such as asthma or nephrotic syndrome in children with influenza.
Influenza / Plastic bronchitis / Allergic disease / Asthma / Child
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