Analysisof Susceptibility Factors And Prognosis Of Bronchiolitisobstructive In Children

Obstructive bronchiolitis(Bronchiolitis Obliterans,BO)is a severe chronic airway obstructive disease that is rare in children.The clinical symptoms of BO vary,usually with subacute or chronic onset,manifested as persistent cough,wheezing,and varying degrees of hypoxia after lung injury,with decreased exercise tolerance.Due to the delay in the course of BO,some cases are prone to respiratory failure and die,so BO has been increasingly concerned.Objective:To study susceptibility factors in children with Bronchiolitis obliterans and analyze the prognosis.Methods:From December 2012 to December 2017,the Department of Pediatric Respiratory First Affiliated Hospital and Inpatient Department of Bethune First Hospital of Jilin University was recruited to meet the diagnosis and treatment of obstructive bronchiolitis in children in the respiratory group of Pediatric Society of Chinese Medical Association in 2012.The proposed standard for children is the subject of this clinical study.A total of 70 children with BO were collected and the general demographic information(gender,age),basic disease information(such as preterm birth,bronchopulmonary development,congenital heart disease,malnutrition,etc.)and history information(pathogens,clinical Performance,mechanical ventilation,history of acute lung injury,etc.),analysis of the prevalence of BO and possible susceptibility factors,and its prognosis and other clinical data.Results1.Population distribution:In this study,70 cases of BO children were included,including 49 males and 21 females,with a ratio of 2.3 to 1.The age of diagnosis of BO was concentrated in infancy and early childhood,with a minimum of 6 months and a maximum of 72 months,of which 17 cases occurred in 0-12 months,accounting for 24.3%;31 cases occurred in 12-24 months,accounting for 44.3%;There were 16 cases at 24-36 months,accounting for 22.9%;4 cases at 36-48 months,accounting for 5.7%;and 2 cases at 48-72 months,accounting for 2.9%.The age at which wheezing began was 67 in the month of 0-36,and there were 3 cases in the period of 36-72 months.There were 41 cases of children in rural areas and 29 children in urban areas.2.History and basic diseases: Among the 70 children with BO,46 patients(65.7%)had a history of severe pneumonia,and 20 patients(28.6%)had a history of respiratory failure,of which 31(44.3%)were accepted by our child ICU.Among the hospitalized patients,19(27.1%)received mechanical ventilation after tracheal intubation and 12(17.1%)received non-invasive end-expiratory continuous positive pressure ventilation.The duration of ICU stay fluctuates from 5 days to 50 days.Nine patients(12.9%)had a history of congenital heart disease.3 cases(4.3%)had fulminant myocarditis in 3 cases(4.3%)with congestive heart failure.Four cases(5.7%)were preterm and low birth weight infants,of whom one was a very low birth weight infant.One case(1.4%)had neonatal respiratory distress syndrome.Two patients(2.9%)had a history of bronchomalacia and throat chondromalacia.Four children(5.7%)had malnutrition.15 patients(21.4%)had anemia.One patient(1.4%)had a history of foreign body inhalation.One case(1.4%)had a history of gastroesophageal reflux disease.One patient(1.4%)had left hematoma.One case(1.4%)had empyema.3.Etiology: Among the 70 cases of BO patients included,21.4%(15/70)of adenovirus antibody IgM(+);37.1%(26/70)of Mycoplasma pneumoniae antibody : IgM(+);1.4%(1/70)of mycoplasma pneumoniae antibody IgM(+)Influenza B virus antibody IgM(+);1.4%(1/70)Mycoplasma pneumoniae antibody IgM(+),Parainfluenza virus antibody IgM(+);12.9%(9/70)influenza B virus antibody IgM(+);2.9%(2/70)Epstein-Barr virus antibody IgM(+);8.6%(6/70)fungal infection;4.3%(3/70)cytomegalovirus antibody IgM(+);4.3%(1 /70)Staphylococcus aureus infection;5.7%(4/70)Streptococcus pneumoniae infection;1.4%(1/70)Stenotrophomonas maltophilia infection;1.4%(1/70)Pseudomonas aeruginosa and pneumonia Klebsiosis mixed infection.4.HRCT features: In HRCT of 70 patients with BO,61(87.1%)had mosaic perfusion imaging,49(70.0%)had bronchiectasis,52(74.3%)had bronchial wall thickening,and 7(10.0)%)There is pleural effusion.5.Pulmonary function:The analysis of the tidal function of 68 children with a diagnosis age < 3 years showed that 23.5%(16/68)had mild obstructive airway dysfunction;67.6%(46/68)had moderate obstructiveness.Ventilatory dysfunction;8.8%(6/68)of severe obstructive ventilatory dysfunction;1 case of 3-5 year old children using pulse oscillation method to determine the airway resistance,the results showed that the surrounding elastic resistance increased;1 case> 5 years old children with conventional lung Measurements of ventilation function,FEVI,FEV1/ FVC,PEF,FEF25,FEF50,and FEF75 were significantly reduced,suggesting severe obstructive airway dysfunction.6?Prognostic analysis(1)The effect of pathogens on prognosis: In this study,70 cases of BO children were divided into adenovirus group,mycoplasma pneumoniae group,and other pathogens group,which were group 1,group 2,group 3,of which 1 group has 15 cases.,accounting for 20.8%,26 cases in 2 groups,accounting for 37.1%,29 cases accounted for 41.4% in 3 groups.The clinical remission rate in group 1 accounted for 0.067,partial remission accounted for 0.20,the clinical condition continued to account for 0.533,and the disease progression deteriorated to 0.067.The clinical remission rate in group 2 accounted for 0.154,partial remission accounted for 0.384,clinical disease continued to account for 0.423,and the deterioration of the disease accounted for 0.038.Clinical remission rate accounted for 0.069,partial remission accounted for 0.069,clinical disease continued to account for 0.862,worsened disease accounted for 0.2%,P = 0.0531;3 vs 1 P = 0.7076,3 vs 2 P = 0.0079.(2)The effect of treatment plan on prognosis: The basic treatment was long-term inhaled glucocorticoid + short-term oral azithromycin(3 months),divided into 3 groups according to treatment plan,based on the basic treatment plan was divided into plus oral hormone group(A Group),plus sir-Ning group(B group),oral hormone + Shun Erning group(C group).In group A,1 case was clinical remission,accounting for 1.4%;clinical partial remission was 4 cases,accounting for 5.7%;clinical cases continued in 15 cases,accounting for 21.4%;condition deteriorated in 1 case,accounting for 1.4%.In group B,1 case was clinically remitted,accounting for 1.4%;6 cases were clinically partial remission cases,accounting for 8.6%;18 cases were persistent clinical cases,accounting for 25.7%;1 case was exacerbated,accounting for 1.4%.In group C,5 cases were clinically remitted,accounting for 7.1%;5 cases were clinically partial remissions,accounting for 7.1%;11 cases were persistent clinical cases,accounting for 15.7%;2 cases were worsened,accounting for 2.8%.The results suggest that the P value is 0.378,which is not statistically significant.(3)The impact of basic history-related diseases on prognosis: In 46 patients with severe pneumonia,there were 0 clinical remission cases,4 partial clinical remission cases,38 clinical cases persistent cases,and 4 clinical cases deteriorated.In 19 cases of mechanical ventilation after tracheal intubation,there were 0 clinical remission cases,1 partial clinical remission,14 cases of persistent clinical conditions,and 4 cases of clinical deterioration.Overall prognosis: Clinical remission cases in 7 cases,accounting for 10.0%;clinical partial remission cases in 15 cases,accounting for 21.4%;persistent cases in 44 cases,accounting for 62.9%;deteriorated cases in 4 cases,5.7%,of which 2 cases developed into BOOP There have been no deaths so far.Conclusion:1? M.pneumoniae infection and adenovirus infection are susceptibility factors of BO.2? The predisposing factors of BO are related to severe pneumonia and mechanical ventilation.Patients with underlying diseases(premature delivery,bronchomalacia,history of foreign body inhalation,etc)have an increased risk of BO.3? Poor prognosis of children with severe pneumonia and history of tracheal intubation.