Analysis Of Etiology And Clinical Characteristics Of 198 Cases In Children With Pleural Effusion

Objective To investigate the etiology and clinical characteristics of 198 cases in children with pleural effusion,and to improve the clinical diagnosis and treatment of pleural effusion in children.Methods1.The clinical data of 198 pleural effusion which had hydrothorax examination admitted in Children’s Hospital of Chongqing Medical University from January 2012 to January 2015 were retrospectively reviewed.The clinical manifestation,laboratory examination,treatment and prognosis of pleural effusion were identified to summarize the etiology and clinical characteristics of pleural effusion in children.2.The statistical analysis were got by SPSS 17.0 software.The normal distribution measurement data was representation by (x±s),the abnormal distribution measurement data was representation by P50(P25, P75),while the enumeration data was representation by percentage.Enumeration data was analyzed with chi-square test,Fisher exact test and Kruskal-Wallis Test,measurement data was analyzed with t-test and rank sum test.And there was significantly difference when P＜0.05.Results1.Out of 198 pleural effusion cases,there were 70 female(35.3%) while 128 were male(64.7%),male:female was 1.8:1.48 cases(24.2%) were from city while 150 cases(75.8%) were from countryside.The children’s age were from 2 months to 15 years and 11 months,the average age was 6.39± 4.23 years old.≤1 year old in 19 cases(9.6%),1～3 years old in 39 cases(19.7%),3-7 years old in 54 cases(27.3%),>7 years old in 86 cases(43.4%).Pleural effusion in children occurred in every month,but paragonimiasis pleuritis was mostly seen in summer and autumn.2.In 198 cases,20 cases(10.1%) were in a small amount of effusion,94 cases(47.5%) were medium effusion,79 cases(39.9%) were large quantity of pleural effusion,5 cases(2.5%) were loculated pleural effusion.In 198 pleural effusion,85 cases(42.9%) were unilateral while 113 cases(57.1%) were bilateral. Unilateral pleural effusion was more common in purulent and tuberculous pleuritis,while bilateral pleural effusion was more common in mycoplasma pneumoniae,paragonimiasis and mixed infection pleuritis.3.Out of 198 cases,there were 135 cases caused by infection(68.2%),in which 54 cases caused by suppuration(27.3%),27 cases caused by paragonimiasis(13.6%),22 cases caused by mycoplasma pneumoniae(11.1%),12 cases caused by tuberculosis infection(6.1%),5 cases caused by epstein-barr virus(EBV)(2.5%),3 cases caused by adenovirus(1.5%),12 cases caused by mixed infection(6.1%). Non-infectious pleural effusion in 29 cases(14.6%),including 21 cases of malignant tumors(10.6%),in which 9 cases of leukemia,6 cases of lymphoma,3 cases of neuroblastoma,1 case of nephroblastoma,1 case of mediastinal rhabdomyosarcoma,1 case of malignant small cell tumor;chylothorax in 5 cases(2.5%),nephrotic syndrome in 1 case(0.5%),trauma in 2 cases(1.0%).The etiology was unknown in 34 cases(17.2%).4.The etiology of pleural effusion were different in different age groups.In≤3 years old group,purulent pleuritis was the main cause which showed statistical difference compared with that in 3-7 years old group and >7 years old group(P<0.001).Children over the age of 3 to mycoplasma pneumoniae infection were more common,compared with≤3 years old group were significantly different (χ2=4.883, P=0.027).Paragonimiasis pleuritis was more common in＞7 years old group than that of other age groups(P<0.001).Tuberculous pleuritis was more common in>7 years old group, compared with≤7 years old group was significantly different (χ2=7.583, P=0.006).Malignant tumorous pleuritis had no significant difference in any age groups.5.54 purulent pleuritis were treated with adequate dosage and duration antibiotics,37 cases(68.5%) of hydrothorax were absorbed within 14 days,13 cases(24.1%) were absorbed after 14 days.27 paragonimiasis were treated with antiparasitics,all cases of hydrothorax were absorbed within 14 days,in which 11 cases(40.7%) were absorbed within 7 days,16 cases(59.3%) were absorbed after 7 days.22 mycoplasma pneumoniae pleuritis were taken azithromycin sequential therapy,18 cases(81.8%) were absorbed within 14 days,2 cases(9.1%) were absorbed over 14 days.12 tuberculous pleuritis were taken regular antituberculous therapy,8 cases(66.7%) were absorbed within 14 days,4 cases(33.3%) were absorbed over 14 days.12 mixed infectious pleuritis were taken anti-infectious treatment,10 cases(83.3%) were absorbed within 14 days,1 case(8.3%) was absorbed over 14 days.21 malignant tumorous pleuritis were taken operation and(or) chemotherapy,4 cases(19.0%) were absorbed within 14 days,10 cases(47.6%) were absorbed over 14 days.The absorption time of pleural effusion were significant difference in every etiology(P<0.001).The hydrothorax of purulent, paragonimiasis, mycoplasma pneumoniae, tuberculous and mixed infectious pleuritis were more common absorbed within 14 days,while malignant tumorous pleuritis were usually absorbed after 14 days.Conclusion1.Infection was the most common cause of pleural effusion in children.Suppuration, paragonimiasis and mycoplasma pneumoniae were the main infective causes.Malignant tumors were the most common cause of non-infectious pleural effusion.2.Unilateral pleural effusion was more common in purulent and tuberculous pleuritis,while bilateral pleural effusion was more common in mycoplasma pneumoniae,paragonimiasis and mixed infection pleuritis.3.The etiology of pleural effusion was closely related to the age of children.Purulent pleuritis was more common in under 3 years old infant,paragonimiasis and tuberculous pleuritis were more common in over 7 years old elder children.Mycoplasma pneumoniae pleuritis was more common in over 3 years old children,while malignant tumorous pleuritis had no obviously distribution in age and it was complicated by polyserous effusion easily.4.After taking etiological and symptomatic treatment,pleural effusion had good prognosis in children.