中重度毛细支气管炎患儿预后不良的风险因素

doi:10.3760/cma.j.cn441417-20250226-13013

摘要/Abstract

摘要：

目的　探讨中重度毛细支气管炎患儿预后不良的风险因素。方法　选取2022年1月至2023年10月陕西中医药大学第二附属医院收治的217例中重度毛细支气管炎患儿作为研究对象，男126例，女91例；年龄1～24（8.77±1.04）个月。所有中重度毛细支气管炎患儿均给予综合常规住院治疗。患儿康复出院后随访1年，将随访期间确诊为哮喘、毛细支气管炎复发及喘息次数≥3次的患儿纳入预后不良组（57例），剩余患儿纳入预后良好组（153例）。收集患儿临床资料，包括一般资料（性别、年龄、早产、特应性体质、喂养方式、烟草暴露史、宠物接触史、湿疹史、哮喘家族史）、临床症状（入院前病程、病情严重度分级、感染病原体）以及实验室指标［治疗前中性粒细胞计数、白细胞计数（WBC）、C反应蛋白（CRP）、免疫球蛋白E（IgE）］。采用独立样本t检验、χ²检验进行统计学分析。采用多因素logistic回归分析患儿预后不良的风险因素；采用方差膨胀因子（VIF）判断自变量间是否存在共线性，并采用受试者操作特征曲线（ROC）分析多因素logistic回归模型对患儿预后不良的预测效能。结果　随访期间，有2例患者转院、5例患者失访，剔除本研究，共纳入210例患者。210例中重度毛细支气管炎患儿预后不良发生率为27.14%（57/210）。预后不良组早产儿、特应性体质、重度毛细支气管炎、有湿疹史、有哮喘家族史占比及IgE水平均高于预后良好组，母乳喂养占比低于预后良好组（均P<0.05）。多因素logistic回归分析结果显示，早产（OR=1.857，95%CI：1.197～2.881）、特应性体质（OR=1.586，95%CI：1.198～2.099）、哮喘家族史（OR=1.474，95%CI：1.094～1.986）、重度毛细支气管炎（OR=2.042，95%CI：1.446～2.883）均是中重度毛细支气管炎患儿预后不良的风险因素，母乳喂养（OR=0.590，95%CI：0.397～0.877）是保护因素（均P<0.05）。ROC结果显示，多因素logistic回归模型预测中重度毛细支气管炎患儿预后不良的曲线下面积（AUC）为0.938（95%CI：0.897～0.967），灵敏度为89.47%，特异度为88.24%。结论　早产、特应性体质、哮喘家族史、重度毛细支气管炎均是中重度毛细支气管炎患儿预后不良的风险因素，母乳喂养是保护因素。

关键词: 预后不良, 中重度毛细支气管炎, 风险因素

Abstract:

Objective　To explore the risk factors for poor prognosis in children with moderate to severe bronchiolitis. Methods　A total of 217 children with moderate to severe bronchiolitis who were admitted to the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from January 2022 to October 2023 were selected as the study subjects. There were 126 boys and 91 girls, aged 1-24 (8.77±1.04) months. All children with moderate to severe bronchiolitis were given comprehensive routine inpatient treatment. After the children were discharged from the hospital, they were followed up for one year. Those diagnosed with asthma, recurrence of bronchiolitis, and having more than 3 episodes of wheezing during the follow-up period were included in the poor prognosis group (57 cases), while the remaining children were included in the good prognosis group (153 cases). The clinical data of the patients were collected, including general information (gender, age, premature birth, atopic constitution, feeding method, history of tobacco exposure, history of pet contact, history of eczema, history of asthma), clinical symptoms (pre-admission disease course, severity grading of the condition, infectious pathogens) and laboratory indicators [neutrophil count, white blood cell count (WBC), C-reactive protein (CRP), immunoglobulin E (IgE) levels before treatment]. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was used to identify the risk factors for poor prognosis in the children; variance inflation factor (VIF) was used to determine whether there was collinearity among the independent variables, and the receiver operating characteristic curve (ROC) was used to analyze the predictive efficacy of the multivariate logistic regression model for poor prognosis in the children. Results　During the follow-up period, 2 patients were transferred to other hospitals and 5 patients were lost to follow-up. Excluding this study, a total of 210 patients were included. Among the 210 children with severe bronchiolitis, the incidence of poor prognosis was 27.14% (57/210). The proportions of premature infants, atopic constitution, severe bronchiolitis, history of eczema, history of asthma in the poor prognosis group, as well as the IgE levels were all higher than those in the good prognosis group, while the proportion of breastfeeding was lower than that in the good prognosis group (all P<0.05). The results of the multivariate logistic regression analysis showed that preterm birth (OR=1.857, 95%CI: 1.197-2.881), atopic constitution (OR=1.586, 95%CI: 1.198-2.099), asthma family history (OR=1.474, 95%CI: 1.094-1.986), and severe bronchiolitis (OR=2.042, 95%CI: 1.446-2.883) were all risk factors for poor prognosis in children with moderate to severe bronchiolitis; breastfeeding (OR=0.590, 95%CI: 0.397-0.877) was a protective factor (all P<0.05). The ROC results showed that the area under the curve (AUC) of the multivariate logistic regression model for predicting poor prognosis in children with moderate to severe bronchiolitis was 0.938 (95%CI: 0.897-0.967), with a sensitivity of 89.47% and a specificity of 88.24%. Conclusion　Premature birth, atopic constitution, family history of asthma, and severe bronchiolitis are all risk factors for poor prognosis in children with moderate to severe bronchiolitis; breastfeeding is a protective factor.

Key words: Poor prognosis, , Moderate to severe bronchiolitis, , Risk factors

高莹张国成杨宝宁.

中重度毛细支气管炎患儿预后不良的风险因素 [J]. 国际医药卫生导报, 2025, 31(13): 2176-2180.

Gao Ying, Zhang Guocheng, Yang Baoning.

Risk factors for poor prognosis in children with moderate to severe bronchiolitis [J]. International Medicine and Health Guidance News, 2025, 31(13): 2176-2180.

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