Objective To explore the clinical characteristics and prognosis of post-infectious bronchiolitis obliterans in children,and to provide reference for its clinical diagnosis and treatment.Methods The clinical data of 152 pediatric patients with post-infectious bronchiolitis obliterans who were admitted to Department of Pediatric Respiratory Medicine,the First Hospital of Jilin University from January 2015 to December 2023 were retrospectively analyzed.The outcomes were compared between the patients with wheezing and the patients without wheezing,or between the patients with atopic constitution and the patients without atopic constitution.The outcomes were compared between the patients treated with systemic glucocorticoids and the patients treated with no systemic glucocorticoids.Results The age of the 152 pediatric patients ranged from 17 months to 17 years,and the age of the majority of the pediatric patients was equal to or more than 6 years( accounting for 69.74％) .The clinical manifestations of the pediatric patients were non-specific.All the 152 pediatric patients with bronchiolitis obliterans had recurrent cough and fever in varying degrees.The median time for diagnosis of bronchiolitis obliterans was 19(15.0,28.5)days.A total of 151 pediatric patients tested positive for pathogens,with 53 cases of single pathogen infection and 98 cases of mixed pathogen infection.A total of 148 pediatric patients were positive for Mycoplasma pneumoniae,and adenovirus infection was the most common infection among the patients with viral infection.All the 152 pediatric patients underwent CT examination of the lungs,and the main findings of the CT examination were consolidation,poor gas content or atelectasis,uneven density,pleural effusion and bronchiectasis.Occlusions of bronchus,segmental bronchus,proximal subsegment or its branches were detected in all the 152 pediatric patients.In the acute stage,phlegm clots or mucus phlegm obstruction in the lumen were showed in 114 cases,plastic bronchitis in 10 cases,rice soup-like lavage fluid and bloody or purulent lavage fluid in 38 cases,subsequently,the manifestations of varying degrees in diseased airway mucosa necrosis,paleness,erosion,peeling or ulceration,and prone to bleeding upon touch in 55 cases,bronchial lumen cartilage structure damage,lumen softening,collapse,twisting,spiral and circular stenosis in 98 cases and fishbone-like changes in 2 cases.Among the 86 patients who were followed up,the improvement rate of lung imaging in the systemic corticosteroids group(69 cases)(73.91％) was higher than that in the non-systemic corticosteroids group(17 cases)(52.94％).The proportion of the patients with atelectasis or poor gas content,uneven ventilation density and bronchiectasis in the systemic corticosteroids group was lower than that in the non-systemic corticosteroids group,but the difference was not statistically significant(P＞0.05).The improvement rate of lung imaging in the non-wheezing or atopic constitution group(66 cases)(78.79％) was higher than that in the wheezing or atopic constitution group(20 cases)(40.00％),and the proportion of uneven ventilation density in the non-wheezing or atopic constitution group was lower than that in the wheezing or atopic constitution group,and the differences were statistically significant(P＜0.05).Conclusion When the clinical manifestations of the pediatric patients are repeated fever,cough,wheezing during the course of the disease or the pediatric patients have atopic constitution,early bronchoscopy findings of airway mucosal necrosis,erosion,lumen stenosis,formation of mucus or sputum embolus,Mycoplasma pneumoniae and/or adenovirus and other pathogenic infections,poor inflammatory resorption of lung imaging and uneven ventilation,clinicians need to pay attention to the possibility of post-infectious bronchiolitis obliterans.
万方数据
