Li C C, Li H Y, Zhu L L, Wen S H, Xu M, Su M S, Dong L
Department of Pediatric Respiratory Medicine, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China.
Zhonghua Er Ke Za Zhi. 2025 Jul 2;63(7):778-783. doi: 10.3760/cma.j.cn112140-20241226-00937.
To analyze the clinical features of children with infection-related eosinophilic lung diseases (ELD) caused by common respiratory pathogens. A retrospective cohort study was conducted. The clinical features, auxiliary examinations, treatments, and prognoses of 134 children with infection-related ELD caused by common respiratory pathogens at Yuying Children's Hospital from January 2014 to June 2024 were collected. Participants were divided into the mild and severe groups based on whether the proportion of eosinophils in bronchoalveolar lavage fluid (BALF) exceeded 0.25. Chi-square test or Fisher exact test was used to analyze the differences between the two groups, and Logistic regression was performed to examine the correlation between BALF eosinophilia and the clinical outcomes. Among the 134 children, 73 were males and 61 were females, with an age of 6.9 (4.6, 8.8) years on admission. A total of 154 pathogen detections were recorded, including 116 cases (75.3%) of , 8 cases (5.2%) of influenza A virus, 6 cases (3.9%) of , and 6 cases (3.9%) of , among others. The percentage of eosinophils in the BALF of all children was 0.10 (0.07, 0.15). There were 117 cases in the mild group and 17 cases in the severe group. Compared with the mild group, significantly greater proportion of children in the severe group presented dyspnea (10/17 17.1% (20/117)), wheezing (7/17 . 8.5% (10/117)), respiratory failure (8/17 7.7% (9/117)), single lobe ≥2/3 consolidation (7/17 12.8% (15/117)), atelectasis (7/17 12.0% (14/117)), pleural effusion (7/17 16.2% (19/117)), plastic bronchiolitis (4/17 4.3% (5/117)), and systemic corticosteroid prescription (14/17 51.3% (60/117)) (all <0.05). Univariate Logistic regression analysis revealed that severe eosinophilia in BALF was significantly associated with an elevated risk of respiratory failure (=10.67, 95% 3.31-34.38, <0.001), single lobe ≥2/3 consolidation (=4.76, 95% 1.57-14.41, =0.006), atelectasis (=5.15, 95% 1.69-15.72, =0.004), pleural effusion (=3.61, 95% 1.22-10.67, =0.020), and plastic bronchitis (=6.89, 95% 1.64-28.94, =0.008). Among the 126 children who were followed up, 106 cases (84.1%) were cured, 20 cases (15.9%) improved, and no relapses or deaths occurred. and influenza A virus are common pathogens in children with infection-related ELD and the percentage of eosinophils in BALF is mildly increased, and the severe cases exhibit more severe clinical features and more significant pulmonary abnormalities, such as lobar consolidation and lung atelectasis. The prognosis is generally favorable.
分析由常见呼吸道病原体引起的感染相关性嗜酸性粒细胞性肺病（ELD）患儿的临床特征。进行了一项回顾性队列研究。收集了2014年1月至2024年6月在育英儿童医院134例由常见呼吸道病原体引起的感染相关性ELD患儿的临床特征、辅助检查、治疗及预后情况。根据支气管肺泡灌洗液（BALF）中嗜酸性粒细胞比例是否超过0.25将参与者分为轻症组和重症组。采用卡方检验或Fisher确切检验分析两组间差异，并进行Logistic回归分析以检验BALF嗜酸性粒细胞增多与临床结局之间的相关性。134例患儿中，男性73例，女性61例，入院时年龄为6.9（4.6，8.8）岁。共记录154次病原体检测结果，其中肺炎支原体116例（75.3%），甲型流感病毒8例（5.2%），肺炎衣原体6例（3.9%），其他病原体6例（3.9%）等。所有患儿BALF中嗜酸性粒细胞百分比为0.10（0.07，0.15）。轻症组117例，重症组17例。与轻症组相比，重症组患儿出现呼吸困难（10/17比20/117，17.1%比8.5%）、喘息（7/17比10/117）、呼吸衰竭（8/17比9/117，7.7%比7.7%）、单叶≥2/3实变（7/17比15/117，12.8%比12.8%）、肺不张（7/17比14/117，12.0%比12.0%）、胸腔积液（7/17比19/117，16.2%比16.2%）、塑形支气管炎（4/17比5/117，4.3%比4.3%）及全身使用糖皮质激素（14/17比60/117，51.3%比51.3%）的比例显著更高（均P<0.05）。单因素Logistic回归分析显示，BALF中严重嗜酸性粒细胞增多与呼吸衰竭风险升高显著相关（比值比=10.67，95%可信区间3.31 - 34.38，P<0.001）、单叶≥2/3实变（比值比=4.76，95%可信区间1.57 - 14.41，P=0.006）、肺不张（比值比=5.15，95%可信区间1.69 - 15.72，P=0.004）、胸腔积液（比值比=3.61，95%可信区间1.22 - 10.67，P=0.020）及塑形支气管炎（比值比=6.89，95%可信区间1.64 - 28.94，P=0.008）。在126例接受随访的患儿中，106例（84.1%）治愈，20例（15.9%）好转，无复发或死亡病例。肺炎支原体和甲型流感病毒是感染相关性ELD患儿的常见病原体，BALF中嗜酸性粒细胞百分比轻度升高，重症病例表现出更严重的临床特征和更明显的肺部异常，如肺叶实变和肺不张。总体预后良好。
