住院儿童社区获得性流感病毒肺炎临床特点分析

Clinical characteristics of community-acquired influenza virus pneumonia in hospitalized children

目的分析住院儿童社区获得性流感病毒肺炎的临床特点,提高临床医师对该病的认识水平。方法收集2009年11月至2018年1月首都医科大学附属北京儿童医院呼吸科及感染科收治住院的70例社区获得性流感病毒肺炎患儿的临床资料,对其临床特点进行分析。结果70例患儿中,61例(89.7%)好转出院,中位年龄3.5岁,0~5岁50例(71.4%);重症肺炎29例,轻症41例;3例死亡;19例(27.1%)有基础疾病。64例(91.4%)冬春季住院。首发症状主要为发热[64例(91.4%)]和咳嗽[65例(92.9%)],体温多在39.1~41.0℃。肺部听诊以湿啰音(30例,58.8%)和喘鸣音(8例,15.7%)为主。流感病毒肺炎肺外并发症多见,心肌损害19例,肝功能损害11例,中毒性脑病4例,电解质紊乱3例,多脏器功能衰竭、噬血细胞综合征各2例,感染性休克1例。肺部影像学双侧病变40例(57.1%),以下叶病变为主(39例),主要表现为斑片影、间实质病变、磨玻璃影和胸腔积液。单一甲型流感病毒肺炎47例(67.1%),混合感染23例(32.9%)。有基础疾病的患儿发生重症肺炎的比例(68.4%)显著高于无基础疾病的患儿(31.4%),差异有统计学意义(χ^2=7.830,P=0.005);重症病例C反应蛋白(CRP)增高的比例(54.3%)显著高于轻症病例(28.6%),差异有统计学意义(χ^2=4.769,P=0.029)。结论儿童社区获得性流感病毒肺炎主要发生在冬春季;多见于5岁以下儿童;主要临床表现为发热和咳嗽,以高热为主,肺外并发症多见;大部分患儿肺部可闻及湿啰音;胸部影像学表现为斑片状阴影或间实质浸润,以双肺、下叶病变为主;存在基础疾病的儿童更易患重症流感病毒肺炎;CRP升高与重症流感病毒肺炎具有相关性;多数患儿预后良好,但仍有死亡病例。

Objective To analyze the clinical characteristics of community-acquired influenza virus pneumonia in hospitalized children and improve the clinicians′ understanding level of this disease. MethodsData of 70 cases with community-acquired influenza virus pneumonia admitted to the Respiratory Department and Infectious Disease, Beijing Children′s Hospital, Capital Medical University, from November 2009 to April 2018 were collected and the clinical characteristics were analyzed. ResultsOf the 70 cases, 61 cases(89.7%) were discharged after improvement.The median age was 3.5 years old, and 50 cases(71.4%) were 0 to 5 years old.There were 29 cases with severe influenza pneumonia, 41 cases with mild influenza pneumonia, 3 cases died, and 19 cases(27.1%) had underlying diseases.Sixty-four cases (91.4%) were hospitalized in winter and spring.The first symptoms were mainly fever in 64 cases (91.4%) and cough in 65 cases (92.9%), and temperatures were mostly from 39.1 ℃ to 41.0 ℃.Lung auscultation was dominated by moist rales (30 cases, 58.8%) and wheezing (8 cases, 15.7%). There were many complications of influenza virus pneumonia, including 19 cases with myocardial injury, 11 cases with liver function injury, 4 cases with toxic encephalopathy, 3 cases with electrolyte disturbance, 2 cases with multiple organ failure, 2 cases with hemophagocytic syndrome, and 1 case with septic shock.Chest radiographic results reveal bilateral inflammation in 40 children (57.1%), prodominatly in lower lobe lesions (39 cases). The common changes were patchy shadow, interstitial parenchymal lesion, ground glass shadow, and pleural effusion.Forty-seven children (67.1%) were infected by influenza A, and 23 children(32.9%) were co-infected.The percentage of severe cases with underlying diseases (68.4%) was significantly higher than that in children without chronic diseases (31.4%), the difference was statistically significant (χ^2=7.830, P=0.005). The increase rate of C reaction protein(CRP) in severe cases (54.3%) was significantly higher than that in mild cases (28.6%), the difference was statistically significant(χ^2=4.769, P=0.029). ConclusionsCommunity-acquired influenza virus pneumonia in children mainly occurs in winter and spring.It is more common seen in children under 5 years of age.The main clinical manifestations of community-acquired influenza virus pneumonia are high fever and cough, extrapulmonary complications are more common.Most children have moist rales and showed bilateral inflammation and lower lobe lesions in chest radiography.Children with underlying diseases are more likely to develop severe influenza virus pneumonia.Elevated CRP is associated with severe influenza virus pneumonia.Most patients have a good prognosis, but there are still cases of death.