目的 探讨儿童肺炎后发生塑型性支气管炎（PB）临床特征性表现及行电子支

目的 探讨儿童肺炎后发生塑型性支气管炎（PB）临床特征性表现及行电子支气管镜诊治的价值。<br>方法 以2017年6月至2019年5月在苏州大学附属儿童医院呼吸科住院治疗，使用过支气管镜进行诊治并符合支气管镜诊治标准的下呼吸道感染性疾病患儿为研究对象，共3 865例。将患儿分成PB组、单纯痰栓堵塞组及无阻塞组［支气管镜下未见分泌物堵塞支气管腔，支气管肺泡灌洗液(BALF)中未见塑形分泌物的下呼吸道感染患儿］，对其临床特征性表现、病原学及免疫功能、影像学等实验室检查结果进行比较分析。<br>结果 3组患儿性别分布差异无统计学意义（P=0.382）。PB组和单纯痰栓堵塞组的年龄均明显大于无堵塞组。3组患儿均有咳嗽。无堵塞组喘息患儿占25.06%（924/3 687例）、单纯痰栓堵塞组占21.00%（21/100例），明显高于PB组的5.13%（4/78例）。PB组发热患儿比例最高占93.59%（73/78例），其次为单纯痰栓堵塞组，占83.00%（83/100例），无堵塞组占71.93%（2 652/3 687例），3组间比较差异有统计学意义（χ2=23.571,P＜0.05）；PB组热峰（39.65±0.6）℃，热程（10.32±3.87） d；单纯痰栓堵塞组热峰（39.57±0.64）℃，热程（9.46±5.13） d；无堵塞组热峰（39.27±0.76）℃，热程（6.89±4.06） d。PB组患儿热峰高于无堵塞组、热程长于无堵塞组,差异均有统计学意义（均P＜0.01）。3 865例患儿行电子支气管镜检查前胸部影像学检查均有肺炎表现、大叶性肺炎及胸腔积液，3组占比第1位的是 PB组［大叶性肺炎占79.49%（62/78例）；胸腔积液占41.03%（32/78例）］，其次是单纯痰栓堵塞组［大叶性肺炎占65%（65/100例），胸腔积液占27%（27/100例）］。PB组的C反应蛋白（CRP）、D-二聚体均明显高于单纯痰栓堵塞组，单纯痰栓堵塞组均明显高于无堵塞组。T淋巴细胞亚群中，CD4+淋巴细胞比例PB组明显降低，CD8+淋巴细胞比例PB组明显升高。3组患儿检出第1位的病原菌均为肺炎支原体（MP），但PB组MP检出率（84.62%,66/78例）明显高于单纯痰栓堵塞组（60.00%,60/100例）和无堵塞组（55.68%,2 053/3 687例),差异有统计学意义(P

目的 探讨儿童肺炎后发生塑型性支气管炎（PB）临床特征性表现及行电子支气管镜诊治的价值。<br>方法 以2017年6月至2019年5月在苏州大学附属儿童医院呼吸科住院治疗，使用过支气管镜进行诊治并符合支气管镜诊治标准的下呼吸道感染性疾病患儿为研究对象，共3 865例。 将患儿分成PB组、单纯痰栓堵塞组及无阻塞组［支气管镜下未见分泌物堵塞支气管腔，支气管肺泡灌洗液(BALF)中未见塑形分泌物的下呼吸道感染患儿］，对其临床特征性表现、病原学及免疫功能、影像学等实验室检查结果进行比较分析。<br>结果 3组患儿性别分布差异无统计学意义（P=0.382）。 PB组和单纯痰栓堵塞组的年龄均明显大于无堵塞组。 3组患儿均有咳嗽。 无堵塞组喘息患儿占25.06%（924/3 687例）、单纯痰栓堵塞组占21.00%（21/100例），明显高于PB组的5.13%（4/78例）。 PB组发热患儿比例最高占93.59%（73/78例），其次为单纯痰栓堵塞组，占83.00%（83/100例），无堵塞组占71.93%（2 652/3 687例），3组间比较差异有统计学意义（χ2=23.571,P＜0.05）；PB组热峰（39.65±0.6）℃，热程（10.32±3.87） d；单纯痰栓堵塞组热峰（39.57±0.64）℃，热程（9.46±5.13） d；无堵塞组热峰（39.27±0.76）℃，热程（6.89±4.06） d。 PB组患儿热峰高于无堵塞组、热程长于无堵塞组,差异均有统计学意义（均P＜0.01）。 3 865例患儿行电子支气管镜检查前胸部影像学检查均有肺炎表现、大叶性肺炎及胸腔积液，3组占比第1位的是 PB组［大叶性肺炎占79.49%（62/78例）；胸腔积液占41.03%（32/78例）］，其次是单纯痰栓堵塞组［大叶性肺炎占65%（65/100例），胸腔积液占27%（27/100例）］。 PB组的C反应蛋白（CRP）、D-二聚体均明显高于单纯痰栓堵塞组，单纯痰栓堵塞组均明显高于无堵塞组。 T淋巴细胞亚群中，CD4+淋巴细胞比例PB组明显降低，CD8+淋巴细胞比例PB组明显升高。 3组患儿检出第1位的病原菌均为肺炎支原体（MP），但PB组MP检出率（84.62%,66/78例）明显高于单纯痰栓堵塞组（60.00%,60/100例）和无堵塞组（55.68%,2 053/3 687例),差异有统计学意义(P

Objective to investigate the clinical characteristics of plastic bronchitis (PB) after pneumonia in children and the value of electronic bronchoscopy in diagnosis and treatment.<br>Methods from June 2017 to may 2019, 3 865 children with lower respiratory tract infection who were hospitalized in the respiratory department of children's Hospital Affiliated to Suzhou University, who had used bronchoscopy for diagnosis and treatment and met the criteria of bronchoscopy, were selected as the research objects. The children were divided into three groups: Pb group, simple sputum plug group and non obstruction group (lower respiratory tract infection with no secretion blocking bronchial cavity under bronchoscope and no plastic secretion in bronchoalveolar lavage fluid (BALF)]. The clinical characteristics, etiology, immune function, imaging and other laboratory examination results were compared and analyzed.<br>Results there was no significant difference in gender distribution among the three groups (P = 0.382). The age of Pb group and simple phlegm plug group was significantly longer than that of non blockage group. All three groups had cough. There were 25.06% (924 / 3687) wheezing children in non blockage group and 21.00% (21 / 100 cases) in simple phlegm blockage group, which were significantly higher than 5.13% (4 / 78 cases) in Pb group. The incidence of fever in Pb group was the highest, accounting for 93.59% (73 / 78 cases), followed by simple sputum plug group (83.00%, 83 / 100 cases), and no blockage group (71.93% (2 652 / 3 687 Cases). The difference between the three groups was statistically significant (χ 2 = 23.571, P < 0.05), In Pb group, the heat peak was (39.65 ± 0.6) ℃, and the heat duration was (10.32 ± 3.87) d; in the simple phlegm embolism blockage group, the heat peak was (39.57 ± 0.64) ℃, and the heat duration was (9.46 ± 5.13) d; in the non blockage group, the heat peak was (39.27 ± 0.76) ℃, and the thermal duration was (6.89 ± 4.06) d. The heat peak of Pb group was higher than that of non blockage group, and the heat duration was longer than that of non blockage group (all P < 0.01). Before bronchoscopy, 3865 children had pneumonia, lobar pneumonia and pleural effusion. The first group in the three groups was Pb group (79.49% (62 / 78 cases) with lobar pneumonia and 41.03% (32 / 78 cases) with pleural effusion), followed by simple sputum plug group (65% (65 / 100 cases) with lobar pneumonia and 27% (27 / 100 cases) with pleural effusion]. The levels of C-reactive protein (CRP) and D-dimer in Pb group were significantly higher than those in simple sputum plug group, and those in simple phlegm plug group were significantly higher than those in non blockage group. In T lymphocyte subsets, the percentage of CD4 + lymphocytes in Pb group was significantly lower than that in Pb group, while that in Pb group was significantly higher. Mycoplasma pneumoniae (MP) was the first pathogen in the three groups, but the detection rate of MP in Pb group (84.62%, 66 / 78 cases) was significantly higher than that in simple sputum plug group (60.00%, 60 / 100 cases) and non blockage group (55.68%, 2 053 / 3 687 cases), the difference was statistically significant (P<br>