Clinical characteristics of plastic bronchitis after pneumonia in children and the value of bronchoscopy in diagnosis and treatment
10.3760/cma.j.cn101070-20190803-00709
- VernacularTitle:儿童肺炎后发生塑型性支气管炎的临床特征性表现及支气管镜诊治价值
- Author:
Lihong CAI
1
;
Shuangshuang LI
;
Chunyan QU
;
Yongdong YAN
;
Meijuan WANG
;
Wei JI
Author Information
1. 苏州大学附属儿童医院呼吸科 215000（现在南通市妇幼保健院儿科 226015）
- From:
Chinese Journal of Applied Clinical Pediatrics
2020;35(21):1638-1642
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics of plastic bronchitis (PB) in children after pneumonia and the value of electronic bronchoscopy in diagnosis and treatment of PB after pneumonia.Methods:A total of 3 865 children with lower respiratory infectious diseases who had been treated by bronchoscope and met the diagnosis and treatment criteria of bronchoscope in the Department of Respiratory, Children′s Hospital Affiliated to Soochow University from June 2017 to May 2019 were studied.The children were divided into 3 groups, the PB group, the phlegm embolism blockage group, and the control group [including children with no secretion blocking the bronchial cavity under bronchoscope and no plastic secretion found in bronchoalveolar lavage fluid (BALF)]. The results of laboratory examinations such as clinical characteristics, etiology, immune function and imaging were compared and analyzed.Results:There was no significant difference in the gender distribution among the 3 groups ( P=0.382). The average age of the PB group and phlegm embolism blockage group was significantly older than that of the control group.All the 3 groups had cough.The proportions of coughing children with asthma in the control group and phlegm embolism blockage group [25.06% (924/3 687 cases) and 21.00% (21/100 cases), respectively] were significantly larger than that in the PB group [5.13% (4/78 cases)]. The PB group had the highest ratio of children with fever [93.59% (73/78 cases)], followed by the phlegm embolism blockage group [83.00% (83/100 cases)] and the control group [71.93% (2 652/3 687 cases)] successively.The difference among the 3 groups was significant( χ2=23.571, P<0.05). The fever peaks of the PB group, phlegm embolism blockage group and control group were (39.65±0.6)℃, (39.57±0.64)℃ and (39.27±0.76)℃, respectively; the fever duration of the above 3 groups were (10.32±3.87) days, (9.46±5.13) days and (6.89±4.06) days, respectively.The PB group had a higher fever peak and longer fever duration than the control group (all P<0.01). Before the electronic bronchoscopy, 3 865 children′s chest imaging examination showed pneumonia.The proportions of patients with lobar pneumonia and pleural effusion were the highest in the PB group [79.49% (62/78 cases) and 41.03% (32/78 cases), respectively], followed by the phlegm plug group [65% (65/100 cases) and 27% (27/100 cases), respectively]. C reactive protein (CRP) and D-dimer levels were the highest in the PB group, followed by the phlegm embolism blockage group and the control group successively.The difference was significant.In T lymphocyte subsets, the PB group had a significantly lower percentage of CD4 + lymphocytes and a significantly higher percentage of CD8 + lymphocytes than the control group.The first pathogen detected in the 3 groups was Mycoplasma pneumonia (MP), but the detection rate of MP in the PB group [84.62% (66/78 cases)] was significantly higher than that in the phlegm embolism blockage group [60% (60/100 cases)] and that in the control group [55.68% (2 053/3 687 cases)]. Conclusions:Older children are prone to PB after pneumonia and fever in the course of disease.The imaging manifestations are lobar pneumonia, pleural effusion, atelectasis, elevated CRP and D-dimer in venous blood laboratory examinations.MP is the first pathogen detected in children with PB after pneumonia.Bronchoscopic alveolar lavage is an effective and safe treatment for PB in clinical practice.
