Department of Respiratory Medicine, National Clinical Research Center of Respiratory Disease, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, NO.56, Nanlishi Road, Beijing, 100045, P. R. China.
BMC Pediatr. 2024 Nov 21;24(1):759. doi: 10.1186/s12887-024-05227-7.
Post-infectious bronchiolitis obliterans (PIBO) is a severe form of chronic obstructive lung disease secondary to severe respiratory tract infections. Knowledge of pediatric PIBO development-associated risk factors may improve selection of appropriate early therapeutic interventions.
The aim of this study was to describe the clinical characteristics of children diagnosed with PIBO, and identify the risk factors for development of PIBO after adenovirus pneumonia.
First, a retrospective observational study was performed of 308 pediatric patients with PIBO (ages < 5 years) that revealed high frequencies of non-invasive/invasive ventilation, co-infection, and atopic conditions. Subsequently, we retrospectively reviewed 131 patients (ages < 5 years) with adenovirus pneumonia who developed BO (included among the 308 children) or not. Logistic regression analysis revealed PIBO development-associated risk factors.
Respiratory symptoms of 308 patients (median age of 18 months, range: 12-54 months; male predominance of 3.7:1) included wheezing (71%), dyspnea (66%), tachypnea (23%), and hypoxemia (18%). Etiologic agents (predominantly adenovirus, Mycoplasma pneumoniae) were detected in 236 patients, of whom 137 had co-infections. Notably, atopic disease history (of patients and/or family members) was associated with 78% of patients, and 15% of patients diagnosed with asthma before, at the time of PIBO diagnosis. In a subsequent study of 131 adenovirus pneumonia patients, multivariate analysis showed that co-infection (OR 4.20, 95% CI 1.29 to 13.63), atopic conditions (OR 29.67, 95% CI 12.16 to 81.67), and duration of fever (OR 1.42, 95% CI 1.10 to 1.83) were independent risk factors for PIBO development following adenovirus pneumonia.
Atopic conditions, co-infections, and duration of fever were identified as risk factors for pediatric post-infectious BO development following adenovirus pneumonia, and PIBO may overlap with asthma, warranting early aggressive treatment and further research to elucidate roles of atopic conditions in BO development.
感染后细支气管炎性闭塞（PIBO）是一种严重的慢性阻塞性肺病，继发于严重的呼吸道感染。了解小儿 PIBO 发展相关的危险因素，可能有助于选择合适的早期治疗干预措施。
本研究旨在描述诊断为 PIBO 的儿童的临床特征，并确定腺病毒肺炎后发生 PIBO 的危险因素。
首先，我们对 308 例年龄小于 5 岁的小儿 PIBO 患者（PIBO）进行了回顾性观察性研究，这些患者经常需要无创/有创通气、合并感染和特应性疾病。随后，我们回顾性分析了 131 例年龄小于 5 岁的腺病毒肺炎患者，这些患者中发生了 BO（包括在 308 例患儿中）或未发生 BO。采用 logistic 回归分析显示 PIBO 发生的危险因素。
308 例患者（中位年龄 18 个月，范围：12-54 个月；男女性别比为 3.7:1）出现的呼吸道症状包括喘息（71%）、呼吸困难（66%）、呼吸急促（23%）和低氧血症（18%）。236 例患儿检测到病原体（主要为腺病毒、肺炎支原体），其中 137 例存在合并感染。值得注意的是，特应性疾病史（患者和/或家庭成员）与 78%的患者相关，15%的患者在 PIBO 诊断前或诊断时被诊断为哮喘。在随后对 131 例腺病毒肺炎患者的研究中，多变量分析显示合并感染（OR 4.20，95%CI 1.29-13.63）、特应性疾病（OR 29.67，95%CI 12.16-81.67）和发热持续时间（OR 1.42，95%CI 1.10-1.83）是腺病毒肺炎后发生 PIBO 的独立危险因素。
特应性疾病、合并感染和发热持续时间被确定为小儿腺病毒肺炎后发生感染后 BO 发展的危险因素，PIBO 可能与哮喘重叠，需要早期积极治疗，并进一步研究特应性疾病在 BO 发展中的作用。
