13例儿童博卡病毒肺炎合并塑型性支气管炎的临床与影像特点

doi:10.12372/jcp.2025.25e0551

摘要/Abstract

摘要：

目的总结儿童博卡病毒肺炎合并塑型性支气管炎的临床及影像学特征及预后。方法回顾性分析2022年1月至2024年1月在我院确诊的13例博卡病毒肺炎合并塑型性支气管炎患儿的临床资料及随访结果。结果共纳入13例患儿,男7例、女6例，中位年龄3.0（1.0~5.0）岁，其中≥3岁8例（61.54%），夏季入院8例（61.54%）。所有患儿均有发热、咳嗽，7例（53.85%）伴有喘息，3例有气促，平均热程（3.92±1.26）天，热峰（39.24±0.40）℃。1例合并中毒性脑病，1例有多形红斑，余无其他脏器功能损害。9例C反应蛋白（CRP）轻度升高，降钙素原（PCT）、乳酸脱氢酶（LDH）轻度升高。胸部CT以炎性实变为主，9例（69.23%）伴有肺不张，4例（30.77%）有少量胸腔积液，肺泡灌洗液细胞分型显示嗜酸细胞比例明显增高。所有患儿均行支气管镜下塑型物取出术，均好转出院，中位住院时间5.0（4.5~6.5）天。随访中1例出现反复喘息，后诊断为哮喘，余预后良好。结论博卡病毒肺炎合并塑型性支气管炎夏季多见，多以高热起病，伴咳嗽喘息，CRP、PCT、LDH无显著升高，影像学以实变、肺不张为主，病程相对较短，不易合并严重的其他脏器功能损害，预后良好。

关键词: 塑型性支气管炎, 博卡病毒, 影像学, 儿童

Abstract:

Objective To characterize the clinical and radiological features and prognosis of children with bocavirus pneumonia complicated by plastic bronchitis. Methods A retrospective analysis was conducted on the clinical data and follow-up results of 13 children diagnosed with bocavirus pneumonia complicated with plastic bronchitis in our hospital from January 2022 to January 2024. Results A total of 13 cases were included, including 7 males and 6 females, with a median age of 3.0 (1.0-5.0) years. Eight cases (61.5%) were hospitalized during summer. All patients presented with fever and cough; 7 (53.8%) had wheezing, and 3 exhibited tachypnea. The mean duration of fever was 3.92±1.26 days, with a peak temperature of 39.24±0.40 °C. Extrapolmonary complications included one case of toxic encephalopathy and one of erythema multiforme; no other organ dysfunction was observed. Laboratory findings revealed mild elevations in C-reactive protein (CRP) in 9 patients, with PCT and LDH were slightly elevated. Chest CT predominantly showed inflammatory consolidation, with atelectasis in 9 cases (69.2%) and small pleural effusions in 4 (30.8%). Bronchoalveolar lavage fluid analysis demonstrated marked eosinophilia. All patients underwent bronchoscopic removal of intraluminal casts and improved clinically, with a median hospital stay of 5.0 (4.5-6.5) days. During follow-up, one child developed recurrent wheezing and was subsequently diagnosed with asthma; the remaining patients had favorable outcomes. Conclusion Bocavirus pneumonia complicated by plastic bronchitis in children are more frequently observed during the summer months. The disease commonly presents with high fever, cough, and wheezing, with minimal elevation in inflammatory markers such as CRP, PCT, and LDH. Radiologically, consolidation and atelectasis are the predominant findings. The disease course is relatively short, and severe multi-organ involvement is uncommon. Overall, the prognosis is favorable.

Key words: plastic bronchitis, human bocavirus, medical imaging, child

中图分类号:

高微微, 邹映雪, 郭永盛, 郭润. 13例儿童博卡病毒肺炎合并塑型性支气管炎的临床与影像特点[J]. 临床儿科杂志, 2025, 43(11): 860-865.

GAO Weiwei, ZOU Yingxue, GUO Yongsheng, GUO Run. Clinical and imaging features of children with bocavirus pneumonia associated with plastic bronchitis[J]. Journal of Clinical Pediatrics, 2025, 43(11): 860-865.

图/表 3

表1

13例hBoV肺炎合并PB患儿临床资料"

患儿	年龄 /岁	性别	症状体征	T_max /℃	胸部影像学	BALF的细胞学分类
例1	5	女	发热咳嗽	39.9	双肺散在炎性实变，双肺纹理粗重伴透过度不均	N23%，E21%，L3%，M51%，上皮细胞2%
例2	5	女	发热咳嗽	39.0	左肺及右肺上叶炎性实变，左侧胸膜增厚，左肺下叶支气管分支欠通畅	N4%，E31%，L8%，M56%，上皮细胞1%
例3	3	女	发热咳嗽	39.5	右肺上叶炎性实变伴肺不张，右肺上叶支气管管腔不通畅	未做
例4	1	女	发热咳嗽喘，呼吸音减低	39.6	右肺上叶大片炎性实变，伴肺不张	N13%，E17%，L4%，M65%，上皮细胞1%
例5	4	男	发热咳嗽，呼吸音减低	38.5	右肺上叶不张，右肺中叶及双肺下叶炎症，右侧胸腔少量积液	N7%，E42%，L6%，M44%，上皮细胞1%
例6	1	女	发热咳嗽喘	39.6	右肺散在炎性实变伴右肺上叶部分不张，右侧胸膜增厚，右肺上叶及中叶支气管分支不通畅	N28%，E13%，L8%，M49%，上皮细胞2%
例7	1	男	发热咳嗽喘	39.0	左肺散在炎性实变伴左肺上叶部分不张，左侧少量胸腔积液，左肺上叶支气管分支欠通畅	N61%，E15%，L5%，M18%，上皮细胞1%
例8	3	男	发热咳嗽，呼吸音减低	39.3	右肺散在炎性实变伴上叶不张，右侧胸腔积液	N81%，E0%，L3%，M15%，上皮细胞1%
例9	5	男	发热咳嗽，喘气促	39.6	双肺炎症，纵膈气肿、间质性肺气肿	N54%，E1%，L5%，M38%，上皮细胞2%
例10	5	女	发热咳嗽，气促、呼吸音减低	38.9	双肺炎症，右肺下叶肺不张，右侧少量胸腔积液	N66%，E12%，L4%，M16%，上皮细胞2%
例11	4	男	发热咳嗽喘	39.0	双肺上叶炎性实变伴左肺上叶部分不张，左肺上叶局部透过度增高，左肺上叶支气管及分支欠通畅	N81%，E5%，L2%，M9%，上皮细胞3%
例12	2	男	发热咳嗽喘	38.8	双肺散在炎性实变，右肺上叶部分不张，双肺部分支气管分支欠通畅	N21%，E1%，L21%，M55%，上皮细胞2%
例13	1	男	发热咳嗽喘，气促、呼吸音减低	39.4	右肺上叶及左肺散在炎性实变，以右肺上叶为著，右肺上叶支气管远端分支欠通畅	N61%，E5%，L6%，M27%，上皮细胞1%

表1

图1

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