Clinical features and influencing factors of plastic bronchiolitis in children

ZHANG Hui; ZHANG Tong-qiang

doi:10.13820/j.cnki.gdyx.20243369

Abstract：Objective To analyze the clinical features and influencing factors of plastic bronchiolitis(PB)in children,providing a reference for early diagnosis and treatment.Methods A total of 419 children with pneumonia who underwent fiberoptic bronchoscopy between August 2022 and August 2024 were enrolled in the study.The children were divided into two groups:the PB group(168 cases)and the non-PB group(251 cases),based on the presence or ab-sence of plastic formation.Baseline data,including gender,age,clinical symptoms,hospital stay,imaging findings,mi-crobiological results,peripheral blood lymphocyte counts,immunoglobulin levels,D-dimer,and lactate(La)levels,were compared between the two groups.The diagnostic efficacy of lymphocyte subgroup absolute counts in PB was analyzed using receiver operating characteristic(ROC)curves.Results The PB group was significantly older than the non-PB group[(8.08±2.58)years vs.(7.40±3.10)years,P＜0.05].The PB group had significantly higher rates of respira-tory distress[71 cases(42.26％)vs.13 cases(5.18％)],decreased breath sounds on the affected side[104 cases(61.90％)vs.45 cases(17.93％)],hypoxemia[12 cases(7.14％)vs.3 cases(1.20％)],atelectasis[98 cases(58.33％)vs.65 cases(25.90％)],and pleural effusion[71 cases(42.26％)vs.48 cases(19.12％)]compared to the non-PB group(all P＜0.05).The PB group had significantly more cases of Mycoplasma pneumonia infection[133 cases(79.17％)vs.100 cases(39.84％),P＜0.05],while the non-PB group had significantly more cases of bacte-rial infections[51 cases(20.32％)vs.0 cases(0％),P＜0.05].The PB group had significantly higher levels of pe-ripheral blood IgE and D-dimer[163.60(47.92,384.85)IU/mL vs.107.60(42.14,244.00)IU/mL;0.25(0.10,0.70)mg/L vs.0.10(0.10,0.25)mg/L,both P＜0.05].The absolute counts of CD3+,CD4+,CD8+,CD19+,and CD56+lymphocytes were significantly lower in the PB group than in the non-PB group(P＜0.05).ROC curve analysis showed the sensitivity and specificity of CD3+,CD4+,CD8+,CD19+,and CD56+lymphocyte absolute counts for predicting PB were 79％,70％,50％,74％,63％and 67％,85％,68％,60％,57％,respectively,with the area under the curve(AUC)values of 0.801,0.846,0.620,0.720,and 0.624,respectively.Conclusion Chil-dren with PB are mainly school-aged,with Mycoplasma pneumonia being the most common pathogen.They have a higher incidence of respiratory distress,atelectasis,and pleural effusion.PB children show more significant decline in cellular immune function,and the absolute counts of CD3+,CD4+,CD8+,CD19+,and CD56+lymphocytes have good sensitiv-ity and specificity for predicting PB.CD4+absolute count has the highest predictive value for PB,with an AUC of 0.864.