Cai J Y, Yan C Y, Wang X Q, Luo Z X, Luo J, Li Q B, Liu E M, Deng Y
Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, National International Science and Technology Cooperation Base for Major Diseases of Child Development, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing 400014, China.
Zhonghua Er Ke Za Zhi. 2023 Aug 2;61(8):719-725. doi: 10.3760/cma.j.cn112140-20230315-00184.
To investigate the risk factors for airway mucus hypersecretion in childhood pneumonia infected by different pathogens. A retrospective cohort included 968 children who were hospitalized for pneumonia (MPP), respiratory syncytial virus (RSV) pneumonia, adenovirus pneumonia and underwent bronchoscopy in Respiratory Department of Children's Hospital of Chongqing Medical University from January 2019 to December 2021 was conducted. The children were divided into two groups distinguished by airway mucus secretion according to the airway mucus hypersecretion score which were scored according to the mucus secretion under the bronchoscope. The demographic characteristics, clinical characteristics, laboratory tests and disease severity of the two groups were compared. And the risk factors for the development of airway mucus hypersecretion in two groups were analyzed. Chi square test, Mann-Whithey test and Fisher exact test were used to analyze the differences between the two groups, and multivariate Logistic regression was used to analyze the influencing factors. There were 559 males and 409 females in the 968 children, with an age of 4.0 (1.4, 6.0) years. Among the 642 children with MPP, 185 cases were in the hypersecretion group and 457 cases were in the non-hypersecretion group. There were 41 cases in the hypersecretion group and 160 cases in the non-hypersecretion group of 201 children with RSV pneumonia. In the 125 children with adenovirus pneumonia, there were 39 cases in the hypersecretion group and 86 cases in the non-hypersecretion group. In these children, the age of children in the hypersecretion group was older than that in the non-hypersecretion group (6.0 (4.0, 7.0) 5.0 (3.0, 7.0) years old, 1.5 (0.5, 3.6) . 0.8 (0.4, 1.6) years old, 2.0 (1.2, 4.5) 1.3 (0.8, 2.0) years old, =35 295.00, 2 492.00, 1 101.00, all <0.05). Through multivariate Logistic regression analysis it found that increased risk of airway mucus hypersecretion was present in childhood MPP with increase in peripheral blood white blood cell count (=3.30, 95% 1.51-7.93, =0.004) or increase in neutrophil ratio (=2.24, 95% 1.16-4.33, =0.016) or decrease in lymphocyte count (=3.22, 95% 1.66-6.31, <0.001) or decrease in serum albumin (=2.00, 95% 1.01-3.98, =0.047). The risk of airway mucus hypersecretion was increased in children with RSV pneumonia combined with elevated peripheral blood eosinophils (=3.04, 95% 1.02-8.93, =0.043). Meanwhile, airway mucus hypersecretion was associated with severe pneumonia (=2.46, 95% 1.03-6.15, =0.047) in children with RSV pneumonia. Older age was associated with increased risk of airway mucus hypersecretion in children with adenovirus pneumonia (=1.02, 95% 1.00-1.04, =0.026). In these children with occurrence of pulmonary rales, wheezes or sputum sounds (=3.65, 95% 1.22-12.64, =0.028) had an increased risk of airway mucus hypersecretion. Neutrophils in bronchoalveolar lavage fluid (BALF) demonstrated higher ratio in hypersecretion group from children with MPP (0.65 (0.43, 0.81) 0.59 (0.34, 0.76), =24 507.00, <0.01), while the proportion of macrophages in BALF was lower (0.10 (0.05, 0.20) 0.12 (0.06, 0.24), =33 043.00, <0.05). Nucleated cell count and neutrophil ratio in BALF were higher in hypersecretion group of children with RSV pneumonia (1 210 (442, 2 100)×10 . 490 (210, 1 510)×10/L, 0.43 (0.26, 0.62) 0.30 (0.13, 0.52), =2 043.00, 2 064.00, all <0.05). The increase in peripheral blood white blood cell count, neutrophil ratio and decrease in lymphocyte count, serum albumin in children with MPP is related to the development of airway mucus hypersecretion. In children with RSV pneumonia, the abnormal increase of eosinophils in peripheral blood has relationship with hypersecretion. The appearance of lung rale, wheezing, and sputum rale are associated with airway mucus hypersecretion in children with adenovirus pneumonia. In addition, local neutrophil infiltration in the respiratory tract is closely related to the occurrence of airway mucus hypersecretion caused by and RSV infection.
为探讨不同病原体感染所致儿童肺炎气道黏液高分泌的危险因素。对2019年1月至2021年12月在重庆医科大学附属儿童医院呼吸科住院并接受支气管镜检查的968例肺炎（支原体肺炎、呼吸道合胞病毒肺炎、腺病毒肺炎）患儿进行回顾性队列研究。根据支气管镜下黏液分泌情况进行气道黏液高分泌评分，将患儿分为气道黏液分泌正常组和气道黏液高分泌组。比较两组患儿的人口学特征、临床特征、实验室检查及疾病严重程度，并分析两组患儿气道黏液高分泌发生的危险因素。采用卡方检验、Mann-Whitney检验和Fisher确切概率法分析两组间差异，多因素Logistic回归分析影响因素。968例患儿中男559例，女409例，年龄4.0（1.4，6.0）岁。支原体肺炎642例患儿中，气道黏液高分泌组185例，非气道黏液高分泌组457例。呼吸道合胞病毒肺炎201例患儿中，气道黏液高分泌组41例，非气道黏液高分泌组160例。腺病毒肺炎125例患儿中，气道黏液高分泌组39例，非气道黏液高分泌组86例。气道黏液高分泌组患儿年龄大于非气道黏液高分泌组（6.0（4.0，7.0）岁对5.0（3.0，7.0）岁、1.5（0.5，3.6）岁对0.8（0.4，1.6）岁、2.0（1.2，4.5）岁对1.3（0.8，2.0）岁，P = 35 295.00、2 492.00、1 101.00，均＜0.05）。多因素Logistic回归分析发现，支原体肺炎患儿外周血白细胞计数升高（P = 3.30，95%CI 1.51 - 7.93，P = （此处原文可能有误，推测为0.004））、中性粒细胞比例升高（P = 2.24，95%CI 1.16 - 4.33，P = 0.016）、淋巴细胞计数降低（P = 3.22，95%CI 1.66 - 6.31，P＜0.001）或血清白蛋白降低（P = 2.00，95%CI 1.01 - 3.98，P = 0.047）时，气道黏液高分泌风险增加。呼吸道合胞病毒肺炎患儿外周血嗜酸性粒细胞升高时气道黏液高分泌风险增加（P = 3.04，95%CI 1.02 - 8.93，P = 0.043）。同时，呼吸道合胞病毒肺炎患儿中，气道黏液高分泌与重症肺炎相关（P = 2.46，95%CI 1.03 - 6.15，P = 0.047）。腺病毒肺炎患儿年龄较大时气道黏液高分泌风险增加（P = 1.02，95%CI 1.00 - 1.04，P = 0.026）。这些患儿出现肺部啰音、喘息或痰鸣音时气道黏液高分泌风险增加（P = 3.65，95%CI 1.22 - 12.64，P = 0.028）。支原体肺炎患儿气道黏液高分泌组支气管肺泡灌洗液（BALF）中中性粒细胞比例较高（0.65（0.43，0.81）对0.59（（此处原文可能有误，推测为0.34，0.76）），P = 24 507.00，P＜0.01），而BALF中巨噬细胞比例较低（0.10（0.05，0.20）对0.12（0.06，0.24），P = 33 043.00，P＜0.05）。呼吸道合胞病毒肺炎患儿气道黏液高分泌组BALF中有核细胞计数及中性粒细胞比例较高（1 210（442，2 100）×10⁶/L对490（210，1 510）×10⁶/L，0.43（0.26，0.62）对0.30（0.13，0.52），P = 2 043.00、2 064.00，均＜0.05）。支原体肺炎患儿外周血白细胞计数、中性粒细胞比例升高及淋巴细胞计数、血清白蛋白降低与气道黏液高分泌的发生有关。呼吸道合胞病毒肺炎患儿外周血嗜酸性粒细胞异常升高与气道黏液高分泌有关。腺病毒肺炎患儿肺部啰音、喘息及痰鸣音的出现与气道黏液高分泌有关。此外，呼吸道局部中性粒细胞浸润与支原体及呼吸道合胞病毒感染所致气道黏液高分泌的发生密切相关。
