Clinical Features And Influence Factors Of Plastic Bronchitis In Children

BackgroundPlastic bronchitis(PB)is an uncommon disease in children.Plastic bronchitis is characterized by the formation of branching casts that partially or completely occlude the airways,which may result in acute respiratory failure,and it has a high mortality.The cause and pathogenesis of plastic bronchitis are not clear yet.Plastic bronchitis has been reported in children after cardiac operations for congenital heart disease,and in children with pulmonary inflammation disease.On account of the clinical manifestation of plastic bronchitis is not specific,early diagnosis is still difficult.Removal of the casts by using bronchoscopy is essential for its treatment.ObjectiveTo investigate the clinical features and index of plastic bronchitis in children with pneumonia and atelectasis.MethodsThe study was conducted between January 2016 and December 2018 in the department of pediatrics of Provincial Hospital Aff-iliated to Shandong University.The included criterias were as flollows.Firstly,the children has been diagnosed with"pneumonia"and"atelectasis"according to the 8th edition of Zhufutang practical pediatrics.Secondly,according to indication of"Chinese guidelines for pediatric flexible bronchoscopy",they received branchofiberoscopy treatment at the time of hospitalization.They were divided into plastic bronchitis group and non-plastic bronchitis group according to the results of fiberoptic bronchoscopy.We made a comparison of clinical features and index between plastic bronchitis group and non-plastic bronchitis group.Results:1.A total of 345cases were enrolled,including 77 cases in plastic bronchitis group and 268 cases in non-plastic bronchitis group.The onset age ranged from5 month to 13years(median,6years)in PB group,and ranged from5 month to 1 3 years(median,6years)in non-PB group.Plastic bronchitis in children with pneumonia and atelectasis usually occurs in pre-school age and school-age,and is rarely seen in infants.The difference in age between two groups was statistically significant(P<0.05).There are no statistical difference sex There was no significant difference in gender and peak seasons between the two groups(P=0.413>0.05).2.The most common clinical manifestations of plastic bronchitis are fever,cough and wheezing,which are not specific.Fever and diminishment of unilateral respiratory sound are more common in plastic bronchitis in children with pneumonia and atelectasis,and the difference between two groups was statistically significant(P<0.05).3.The number of patients with eosinophilic pneumonia or pleural effusion in the plastic bronchitis group was higher than that in the non-plastic bronchitis group,and the difference between two groups was statistically significant(P<0.05).There was no statistical difference in the number of children with other potential diseases,such as asthma,allergic rhinitis and congenital heart disease,between the two groups(P>0.05).4.Bronchial casts were found in 28 cases(36.4%)in the basal segment of the lower left lobe,and in 29 cases(37.7%)in the basal segment of the lower right lobe.Basal segment of right inferior lobe and right inferior lobe was the segments most commonly affected.5.The percent of neutrophile granulocyte、CRP、LDH、PCT、D-Dimer、fibrinogen、IgE、CD19+ T-cells in plasma in PB group are higher than those in non-PB group,and CD3+ T－cells、CD3+CD4+ T-cells in plasma in PB group are less than those in non-PB group.The difference between two groups was statistically significant(P<0.05).6.There were 63 patients with positive mycoplasma pneumoniae(MP)in PB group,and MP is the most common pathogen of plastic bronchitis in children with pneumonia and atelectasis.There was no statistical difference in pathogens between PB group and non-PB group(P<0.05).Conclusions1.Plastic bronchitis in children with pneumonia and atelectasis usually occurs in pre-school age and school-age,and is rarely seen in infants.2.Mycoplasma pneumoniae is the most common pathogen in plastic bronchitis in children with pneumonia and atelectasis,It may be related to the epidemiological characteristics of the pathogens in this area.3.Generally,bronchial cast can be find in a single bronchus in plastic bronchitis in children with pneumonia and atelectasis.Basal segment of right inferior lobe and right inferior lobe was the segments most commonly affected.4.Fever,diminishment of unilateral respiratory sound and pleural effusion are more common in plastic bronchitis in children with pneumonia and atelectasis,We should be vigilant in clinical practice.5.Whether allergic diseases have an effect on the formation of plastic bronchitis remains to be further explored.6.The degree of inflammatory damage and coagulation dysfunction of plastic bronchitis are more serious,and its cellular immune function is inhibited.The percent ofneutrophile granulocyte、CRP、LDH、PCT、D-Dimer、fibrinogen、CD3+T-cells and CD3+CD4+T-cells in plasma were predictive for the early diagnosis of plastic bronchitis.