中国实用儿科杂志 ›› 2025, Vol. 40 ›› Issue (6): 508-513.DOI: 10.19538/j.ek2025060613

• 论著 • 上一篇    下一篇

儿童感染相关塑形性支气管炎临床特征分析

  

  1. 天津大学儿童医院,天津  300074
  • 出版日期:2025-06-06 发布日期:2025-08-29
  • 通讯作者: 邹映雪,电子信箱:zouyingxue2015@126.com
  • 基金资助:
    天津市自然科学基金重大项目(20JCZDJC00630);天津市卫生健康科技项目(TJWJ2022QN081); 天津市医学重点学科(专科)建设(TJYXZDXK-040A)

Clinical characteristics of infection-related plastic bronchitis in children

  1. Children’s Hospital of Tianjin University,Tianjin  300074,China
  • Online:2025-06-06 Published:2025-08-29

摘要: 目的 分析儿童感染相关塑形性支气管炎(plastic bronchitis,PB)的临床特征,探讨儿童 PB 的发生年龄、季节及感染病原体的特点,为 PB 早期识别及制定可行性治疗方法提供依据。方法 回顾性分析2017年1月至2023年12月天津大学儿童医院收治的1062例临床诊断为 PB 病例的临床资料,分析其发病季节、年龄、病原学的规律,PB 合并肺内及肺外并发症及总体预后特点。结果 1062例感染相关 PB 患儿的季节分布为:春季(149例,14.0%)、夏季(186例,17.5%)、秋季(367例,34.6%)、冬季(360例,33.9%),好发季节为秋冬季。年龄分布为:0~1岁(244例,23.0%)、>1~3岁(142例,13.4%)、>3~6岁(229例,21.6%)、>6~12岁(410例,39.4%)、>12~18岁(28例,2.7%),好发年龄为6~12岁(39.4%)。病原学分布为:未检测到明确病原体(443例,41.7%)、病毒感染(29例,2.7%)、肺炎支原体感染(503例,47.4%)、细菌感染(9例,0.8%)、混合感染(78例,7.3%),最常见的病原体为肺炎支原体。肺内并发症发病率为:胸膜炎(245例,23.1%)、肺不张(246例,23.2%)、胸腔积液(258例,24.3%)。肺外并发症的发病率为:神经系统(20例,1.9%),循环系统(20例,1.9%),血液系统(17例,1.6%),消化系统(88例,8.3%),泌尿系统(89例,8.4%),皮肤黏膜损伤(31例,2.9%),以消化系统和泌尿系统为主。患儿平均住院天数为7.0(5.0,10.0)d,出院后随访3个月至1年,复查胸部影像学恢复时间为:出院后2周340例(32.0%),出院后4周702例(66.1%),出院后8周954例(89.8%),出院后6月1039例(97.8%);另有23例(2.2%)在出院后6月 ~1年间胸部影像学基本恢复,或原有病变部位遗留条带状密度增高影、条索影等改变。结论 PB 好发于秋冬季,多见于 >6~12岁儿童,最常见的病原体为肺炎支原体,总体预后良好。

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Abstract: Objective To analyze the clinical features of infection-associated PB (Plastic Bronchitis) in children, to explore the characteristics of age and season of occurrence, and infectious agents of PB in children, and to provide a basis for the early recognition of PB and the development of feasible treatments. Methods The clinical data of 1062 cases with clinical diagnosis of PB admitted to Tianjin Children’s Hospital from January 2017 to December 2023 were retrospectively analyzed to analyze the patterns of season, age, and etiology of onset, as well as the combined intrapulmonary and extrapulmonary complications of PB and the overall prognostic characteristics. Results A total of 1062 children with infection-related PB were enrolled in this study. The seasonal distribution was: spring (149 cases,14.0%), summer (186 cases, 17.5%), fall (367 cases, 34.6%), and winter (360 cases, 33.9%), with higher incidence in fall and winter. The age distribution was: 0-1 year old (244 cases, 23.0%), >1-3 years old (142 cases, 13.4%),>3-6 years old (229 cases, 21.6%), >6-12 years old (410 cases, 39.4%), >12-18 years old (28 cases, 2.7%),and the prevalent age was 6-12 years old (39.4%). The etiologic distribution was as follows: no definite pathogen detected (443 cases, 41.7%), viral infection (29 cases, 2.7%), Mycoplasma pneumoniae infection (503 cases,47.4%), bacterial infection (9 cases, 0.8%), and mixed infections (78 cases, 7.3%), with Mycoplasma pneumoniae being the most common pathogen. The incidence of 
intrapulmonary complications was pleurisy (245 cases,23.1%), pulmonary atelectasis (246 cases, 23.2%),and pleural effusion (258 cases, 24.3%). The incidence of extrapulmonary complications was as follows:neurological system (20 cases, 1.9%), circulatory system (20 cases, 1.9%), hematologic system (17 cases, 1.6%),
digestive system (88 cases, 8.3%), urological system (89 cases, 8.4%), and skin and mucous membrane injuries (31 cases, 2.9%), with a predominance of the digestive system and the urinary system. The median length of hospital stay for all patients was 7.0 (5.0, 10.0) days. Follow-up was conducted for 3 months to 1 year after discharge. The resolution of chest imaging findings was observed in 340 cases (32.0%) at 2 weeks after discharge, 702 cases (66.1%) at 4 weeks,954 cases (89.8%) at 8 weeks, and 1,039 cases (97.8%) at 6 months. An additional 23 cases (2.2%) achieved nearcomplete resolution between 6 months and 1 year after discharge, or were with residual linear opacities or fibrotic-like changes at previously affected sites. Conclusion PB occurs more often in fall and winter, mostly in children >6-12 years old, the most common pathogen is Mycoplasma pneumoniae, and the overall prognosis is good.

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