复发性哮吼患儿耳鼻喉科转诊及显微喉支气管镜检查结果的预测因素：一项10年队列研究。
Predictors of ENT Referral and Microlaryngobronchoscopy Findings in Children With Recurrent Croup: A 10-Year Cohort Study.
文献信息
| PMID | 42866970 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Noon Nassr |
| 作者单位 | Mid Yorkshire Teaching Trust, Pinderfields Hospital, Wakefield, UK. |
| 期刊 | Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery |
| SCI 分区 | Q2 |
| IF | 2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 确定复发性哮吼患儿耳鼻喉科转诊及显微喉支气管镜检查（MLB）结果的预测因素。
设计： 回顾性队列研究。
地点： 大型地区综合NHS信托机构（2013-2023年）。
参与者： 12个月内发生≥2次哮吼发作或临床医生诊断为复发性哮吼的<18岁儿童。
主要结局指标： 耳鼻喉科转诊、MLB实施及异常MLB结果。
结果： 128名儿童符合复发性哮吼标准（中位年龄13.5个月，中位发作5次）。62名（48%）被转诊至耳鼻喉科，其中34名（55%）接受了MLB。13例（38%）MLB正常。异常包括声门下狭窄（n=5）、动态气道塌陷（n=4）、声带病变（n=3）、非特异性炎症/刺激改变（n=3）和声门下病变（n=5），后者需要手术切除。被转诊的儿童更年轻（中位12个月 vs. 17个月，p=0.038）且发作次数更多（中位5.5次 vs. 4.0次，p=0.013）。耳鼻喉科转诊与耳鼻喉相关疾病（26%，p<0.001）、胃食管反流（24%，p=0.021）和反复病毒感染（47%，p=0.022）相关。MLB在耳鼻喉相关疾病（38%，p<0.001）和反流（32%，p=0.003）中更常见。调整后，仅发作次数预测耳鼻喉科转诊（每增加一次发作aOR 1.09，95% CI：1.01-1.19），没有因素预测MLB或异常发现。
结论： 复发性哮吼需要耳鼻喉科评估，而MLB应保留给有提示显著气道病理的危险特征儿童。尽管大多数接受内镜检查的儿童结果正常或接受保守治疗，但相当一部分少数儿童存在临床重要异常，包括需要手术干预的声门下病变。传统危险因素预测价值有限，支持开展前瞻性多中心研究以完善风险分层。
英文摘要
OBJECTIVE: To determine predictors of ENT referral and microlaryngobronchoscopy (MLB) findings in children with recurrent croup.
DESIGN: Retrospective cohort study.
SETTING: Large district general NHS trust (2013-2023).
PARTICIPANTS: Children < 18 years with ≥ 2 croup episodes in 12 months or a clinician diagnosis of recurrent croup.
MAIN OUTCOME MEASURES: ENT referral, MLB performance and abnormal MLB findings.
RESULTS: 128 children met recurrent croup criteria (median age 13.5 months, median 5 episodes). Sixty-two (48%) were referred to ENT, of which 34 (55%) underwent MLB. Thirteen (38%) MLBs were normal. Abnormalities included subglottic stenosis (n = 5), dynamic airway collapse (n = 4), vocal-cord pathology (n = 3), non-specific inflammatory/irritative change (n = 3) and subglottic lesions (n = 5), with the latter requiring surgical excision. Referred children were younger (median 12 vs. 17 months, p = 0.038) and had more episodes (median 5.5 vs. 4.0, p = 0.013). ENT referral correlated with ENT-related conditions (26%, p < 0.001), gastro-oesophageal reflux (24%, p = 0.021) and recurrent viral infections (47%, p = 0.022). MLB was more common with ENT-related conditions (38%, p < 0.001) and reflux (32%, p = 0.003). After adjustment, only episode count predicted ENT referral (aOR 1.09 per episode, 95% CI: 1.01-1.19), no factor predicted MLB or abnormal findings.
CONCLUSIONS: ENT review is warranted for recurrent croup, whereas MLB should be reserved for children with red-flag features suggesting significant airway pathology. Although most scoped children had normal or conservatively managed findings, a meaningful minority had clinically important abnormalities, including subglottic lesions requiring surgical intervention. Conventional risk factors offer little predictive value, supporting prospective multi-centre studies to refine risk-stratification.