| PartⅠRetrospectively analysis of the clinical features of 17 cases of acute exogenous lipid pneumonia in children.Objective:Acute exogenous lipoid pneumonia(ELP)is a clinically uncommon disease which is mainly due to aspiration of oil substances in children.At present,most of ELPs are case reports or case series reports,and there is no unified diagnosis and treatment guideline at home and abroad.We retrospectively analyzed the clinical features of 17 children with ELP and discussed the diagnosis and treatment plan.Methods:Clinical data of a total of 17 children with AELP(AELP group)admitted to the Department of Pediatrics of the First Affiliated Hospital of Guangzhou Medical University from 2014 to 2021 were collected,including gender,age,length of stay,heat course,inflammatory markers,blood gas analysis,etiological examination,imaging changes,etc.The clinical characteristics and auxiliary examination results of children with different hospitalization days,different heat course and heat peak,and the clinical characteristics and auxiliary examination results of children with different alveolar lavage times were compared.Results:1.There were 9 males and 8 females in the AELP group,the age of onset was(65.24±10.34)months,the duration of disease before admission was(4.53±1.18 days),and the length of hospitalization was 11(8.5～21)days.2.The main manifestations of AELP were cough,fever,vomiting and labored breathing.Children with fever had a fever course of 7(4～15.5)days,and the average length of hospitalization in children with fever course≤7 days(10.38±3.46)was less than that in children with fever course>7 days(23.60±6.62).The average hospitalization days of children with thermal peak≤39℃(8.00±2.71)were less than that of children with thermal peak≥39.1℃(18.78±7.53).3.In the AELP group,the average white blood cells were(15.62±2.21)×10~9/L,and there were 14 cases with elevated white blood cells.The difference was statistically significant when the time interval between exposure to oily substances and collection of laboratory specimens was less than 1 day and>1 day(t=2.492,P=0.025).The C-reactive protein of AELP group was 5.67(0.82,7.48),and 4 cases were higher than normal.There was a statistically significant difference in CRP between exposure to oily substances≤1day and>1 day(t=2.691,P=0.017).Lactate dehydrogenase in AELP group was 310.00(227.00,453.00),and there were 11 cases(64.71%)with elevated lactate dehydrogenase.Spearman correlation analysis showed that there was a positive correlation between lactate dehydrogenase and length of stay.In the AELP group,10 cases showed positive results of pathogenic infection,mainly mycoplasma and Moraxella catarrata.There were 5 cases of mixed infection.Binary Logistic regression was used to evaluate the effects of WBC,CRP and LDH on the length of hospital stay.Finally,the Logistic model was statistically significant,χ~2=8.951,P=0.03.4.In the AELP group,the chest radiographs were mainly characterized by increased lung texture/thickening and spotty or patchy shadows with increased density of lung parenchyma,while the chest CT examination was mainly characterized by spot-shaped,patchy or cord-shaped shadows with increased density or solid shadows.Lung lesions accumulated in both lungs in 9 cases,and most of the lung lesions accumulated in the lower lungs.5.Sixteen children were treated with intravenous glucocorticoid after admission,and the initial dose of intravenous glucocorticoid was less than 1mg/kg·d in 9 cases and greater than 1mg/kg·d in 7 cases.The length of hospitalization between the two groups was statistically significant.In the AELP group,mucosal congestion and swelling were the main manifestations under bronchoscopy.8 cases received one bronchoscopic alveolar lavage,and 9 cases received multiple bronchoscopy.Conclusions:1.Acute exogenous lipid pneumonia caused by mistaken ingestion of oily substances can be more common in school-age children whose parents are negligent.Cough,fever and vomiting are the most common clinical manifestations.Children with heat duration>7 days and heat peak≥39.1℃may be more serious and require longer hospital stay.2.The white blood cells and C-reactive protein of children who ingest oily substances by mistake can be increased within 1 day.There was a correlation between lactate dehydrogenase and length of stay.Most lung lesions in children with AELP involve the lower lung.3.Post-admission treatment with an initial dose of intravenous glucocorticoid greater than 1mg/kg·d may be more effective than an initial dose less than 1mg/kg·d.PartⅡTo compare the clinical characteristics of children with AELP,community-acquired pneumonia and airway foreign bodyObjective:Community-acquired pneumonia(CAP)is still the leading cause of death in children under 5 years of age worldwide.Solid foreign bodies in trachea and bronchus are one of the most common acute pneumonia in children.We compared the clinical characteristics,laboratory results,radiographic changes and treatment characteristics of Airway foreign body(AFB)patients with AELP and the children with community-acquired pneumonia and airway foreign body(AFB)at the same time,and discussed the diagnosis and treatment plan.Methods:30 children with community-acquired pneumonia(CAP group)and 30 children with airway foreign body(AFB group)admitted to the Department of Pediatrics of the First Affiliated Hospital of Guangzhou Medical University from 2014 to 2021 were randomly selected,and their clinical data were collected.The clinical characteristics of 17 children with AELP were compared with 30 children with community-acquired pneumonia(CAP group)and 30 children with airway foreign body(AFB group).Results:1.There was no statistically significant difference in the age of onset among the AELP,CAP and AFB groups.Hospitalization days were 7(5,9)days in the CAP group and 3.5(2,5)days in the AFB group.The number of days in hospital in AELP,CAP and AFB groups was significantly different(H=36.557,P<0.001).Length of stay AELP group>CAP group>AFB group.2.In the AELP group,children were more likely to have cough,vomiting,fever and shortness of breath.The average heat course of CAP group was(4.70±0.52)days,and AFB group was 2(1,3)days.According to Kruskal-Wallis H test,AELP group had the longest heat course,followed by CAP group and AFB group.3.AELP group,CAP group and AFB group had the highest white blood cells,followed by AFB group and CAP group.The C-reactive protein in AELP group was significantly higher than that in CAP and AFB groups.The procalcitonin in AELP group was significantly higher than that in CAP group and AFB group.The proportion of T lymphocytes in AELP group was higher than that in the other two groups,and the inhibition of T lymphocytes was the main factor.Etiology was roughly similar among the three groups.Compared with the CAP and AFB groups,the lung lesions in the AELP group were more likely to accumulate in the lower lung.Conclusion:1.There was no significant difference in age of onset between the AELP group,CAP group and AFB group,but children with AELP needed longer hospital stay than the other two groups.2.The main manifestations of AELP are cough,vomiting,fever and shortness of breath,and the heat course of AELP is significantly higher than that of the other two groups.This suggests that for children suspected of having CAP or AFB,if the children are accompanied by vomiting and the heat course is long,the medical history of the children should be inquired in detail to avoid missing diagnosis of AELP.3.AELP was higher than the other two groups in leukocyte,CRP and PCT.In the analysis of TBNK cells in the three groups of children,we found that the T-lymphocyte inhibition in the AELP group was higher than that in the other two groups. |
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