Wen X H, Yang H M, Zhang X Y, Li H M, He R X, Xu W H, Guan Y Y, Liu J R, Zhao S Y, Zhao C S
Department No.2 of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2025 Jul 2;63(7):772-777. doi: 10.3760/cma.j.cn112140-20250228-00158.
To explore the risk factors for bronchiolitis obliterans (BO) after bronchiolitis in children. A retrospective cohort study was conducted on 122 children diagnosed with bronchiolitis in Department No.2 of Respiratory Medicine of Beijing Children's Hospital, Capital Medical University, from March 2017 to December 2024. Clinical data, including general information, clinical manifestations, imaging findings, laboratory tests, and outcomes, were analyzed. Patients were divided into BO and non-BO groups based on the presence of BO. Differences between groups were assessed using Mann-Whitney test, ² test, or Fisher exact test. Logistic regression and receiver operating characteristic (ROC) curve analysis were employed to identify risk factors and evaluate predictive performance. Among 122 children (73 males, 49 females), the age at onset was 5.0 (2.4, 7.1) years. The BO group included 21 patients, and the non-BO group 101. The BO group exhibited significantly longer durations of persistent high fever and higher peak levels of C-reactive protein, lactate dehydrogenase, and D-dimer compared to the non-BO group (9 (7, 11) 4 (2, 6) d, 19 (7, 35) 10 (7, 18) mg/L, 438 (337, 498) 315 (274, 351) U/L, 0.36 (0.27, 0.91) 0.21 (0.15, 0.29) mg/L, =295.00, 743.50, 463.50, 470.50, all <0.05). The BO group also had higher proportions of resting oxygen saturation <0.95 on room air (100.0% (21/21) 43.6% (44/101)), inspiratory retractions (57.1% (12/21) 18.8% (19/101), ²=11.53), and adenovirus co-infection (38.1% (8/21) . 5.0% (5/101)) (all <0.05). Multivariate Logistic regression identified prolonged high fever (=1.83, 95% 1.31-2.58, <0.001), inspiratory retractions (=10.48, 95% 1.72-63.85, =0.011), and adenovirus co-infection (=42.47, 95% 4.04-446.87, =0.002) as independent risk factors for BO. ROC curve analysis revealed that a fever duration cutoff of 7.5 days predicted BO with 0.71 sensitivity and 0.92 specificity. Prolonged high fever (≥7.5 days), inspiratory retractions, and adenovirus co-infection are significant predictors of BO after bronchiolitis in children, which are helpful for early clinical identification.
探讨儿童毛细支气管炎后闭塞性细支气管炎（BO）的危险因素。对2017年3月至2024年12月在首都医科大学附属北京儿童医院呼吸内科二病区确诊为毛细支气管炎的122例儿童进行回顾性队列研究。分析临床资料，包括一般信息、临床表现、影像学检查结果、实验室检查及转归。根据是否存在BO将患者分为BO组和非BO组。采用Mann-Whitney检验、χ²检验或Fisher确切概率法评估组间差异。采用Logistic回归和受试者工作特征（ROC）曲线分析确定危险因素并评估预测效能。122例儿童中（男73例，女49例），发病年龄为5.0（2.4，7.1）岁。BO组21例，非BO组101例。与非BO组相比，BO组持续高热时间显著延长，C反应蛋白、乳酸脱氢酶及D-二聚体峰值水平更高（9（7，11）比4（2，6）天，19（7，35）比10（7，18）mg/L，438（337，498）比315（274，351）U/L，0.36（0.27，0.91）比0.21（0.15，0.29）mg/L，Z=295.00、743.50、463.50、470.50，均P<0.05）。BO组静息时室内空气下氧饱和度<0.95、吸气三凹征及腺病毒合并感染比例也更高（100.0%（21/21）比43.6%（44/101））、（57.1%（12/21）比18.8%（19/101），χ²=11.53）、（38.1%（8/21）比5.0%（5/101））（均P<0.05）。多因素Logistic回归分析显示，持续高热（OR=1.83，95%CI 1.31-2.58，P<0.001）、吸气三凹征（OR=10.48，95%CI 1.72-63.85，P=0.011）及腺病毒合并感染（OR=42.47，95%CI 4.04-446.87，P=0.002）是BO的独立危险因素。ROC曲线分析显示，发热持续时间截断值为7.5天预测BO的敏感度为0.71，特异度为0.92。持续高热（≥7.5天）、吸气三凹征及腺病毒合并感染是儿童毛细支气管炎后BO的重要预测因素，有助于临床早期识别。
