关键词: 塑型性支气管炎, 腺病毒, 临床特点, 预后

Abstract:

Objective To study the clinical features and prognosis of adenovirus pneumonia complicated with plastic bronchitis in children. Methods The clinical data and follow-up results of 11 children with adenovirus pneumonia complicated with plastic bronchitis diagnosed in hospital from January 2018 to December 2022 were retrospectively analyzed. Results The median age of the 11 patients (7 boys and 4 girls) was 6.0 years old. All of them had fever and cough, 3 children were accompanied by wheezing, 6 had shortness of breath, and 7 had decreased breathing sounds. The mean duration of fever was (7.55±3.59) days, the mean peak of temperature was (39.95±0.79) ℃. There were 7 children with toxic encephalopathy and 8 with liver function impairment. The LDH, IL-6 and PCT levels were increased to different degrees in all patients, and CRP>30mg/L was found in 7 patients. Chest CT+3D reconstruction showed that lung consolidation was the main lesion, including atelectasis in 6 cases and pleural effusion in 4 cases. Six patients were administered with intravenous immunoglobulin, and 9 patients received methylprednisolone. Five patients received facial mask oxygen inhalation. One child received mechanical ventilation, and then changed to V-V-ECMO. All children underwent bronchoscopy and plastic body removal. Among them, 7 patients received bronchoscopy once and 4 received bronchoscopy twice. One child died and the others were discharged after improvement. During follow-up, 1 child had recurrent cough and wheezing, and the others had good prognosis. Conclusions Adenovirus pneumonia with plastic bronchitis is usually characterized by persistent high fever, shortness of breath, hypoxia, reduced breath sound, and significantly increased levels of CRP, PCT and LDH. Most of the imaging findings show atelectasis and lung consolidation, which are easy to combine with other organ injuries. Active anti-inflammatory therapy and bronchoscopy should be performed as soon as possible. Most of patients have a well prognosis, while a few may have poor prognosis such as recurrent cough and wheezing.

Key words: plastic bronchitis, adenovirus, clinical feature, prognosis