Risk Factors in Children with Community-Acquired Pneumonia Combined with Plastic Bronchiolitis

ZHANG Lingyu; XU Longwei; LI Min; ZHANG Guojun

doi:10.3969/j.issn.1004-437X.2026.03.004

Abstract：Objective To analysis of risk factors associated with community-acquired pneumonia(CAP)with plastic bronchiolitis in children.Methods Clinical data of children with CAP who were hospitalized for fiberoptic bronchoscopy with alveolar lavage therapy(referred to as fiberoptic diagnosis and treatment)in the Children's Hospital Affiliated to Zhengzhou University from July to November 2023 were retrospectively analyzed.Results Two hundred and twenty-nine children with CAP who underwent fiberoptic diagnosis and treatment were included,including 119 males and 110 females,with an age of(7.0±2.7)years.Mycoplasma pneumoniae was the main pathogen,accounting for 93.4％(214/229).Plastic bronchiolitis was complicated in 85 of 229 children with CAP.Compared with the plasmapheresis group,the non-plasmapheresis group had a lower proportion of fever,adenovirus infection,positive sputum culture,solid lung area with a long diameter of＞5 cm,and pleural effusion despite the application of glucocorticoids for 6-72 hours,lower levels of C-reactive protein,interleukin-6,calcitoninogen,lactate dehydrogenase,D-dimer,and ghrelin,and higher absolute levels of lymphocyte count(P＜0.05).The results of bicategory logistics regression analysis showed that fever even after 6-72 hours of hormone application,adenovirus infection,positive sputum culture,presence of pleural effusion,low absolute value of lymphocyte count,and high level of interleukin-6 were independent risk factors for children with CAP and plasmacytoid bronchiolitis(P＜0.05).Conclusion Children with CAP who remain febrile 6-72 hours after hormone application,adenovirus infection,positive sputum culture,presence of pleural effusion,low absolute lymphocyte counts,and high interleukin-6 levels are susceptible to concurrent plasmacytoid bronchiolitis,and should undergo early fibrilloscopy.