支气管肺泡灌洗液联合血清学诊断免疫正常婴儿巨细胞病毒肺炎分析

Clinical Characteristics of Cytomegalovirus Pneumonia in Immunocompetent Infants Diagnosed by Bronchoalveolar Lavage Fluid Plus Serology

目的免疫正常婴儿巨细胞病毒(CMV)肺炎的临床特点。方法对免疫功能正常,经支气管肺泡灌洗液CMV-DNA和血清CMV-Ig M检测,并排除合并其他病原感染,确诊为CMV肺炎的患儿进行分析。结果 13例患儿纳入,男:女=8:5;年龄1-3个月10例;入院时病程>2周7例。咳嗽100%;气促76.9%;喘息61.5%;发绀23%;发热30.8%;肺部湿性啰音92.3%;部分伴肝功能和听力异常。血常规淋巴细胞升高,84.6%CRP正常。胸部CT提示4例实质改变,6例间质改变,3例实质合并间质改变。12例予不同疗程更昔洛韦治疗,1例仅给予丙种球蛋白治疗。所有病人临床改善,影像学病灶吸收好转。治疗期间1例出现可逆性外周血粒细胞降低。结论免疫正常婴儿CMV肺炎临床表现为病程较长的咳嗽,喘息、气促症状较常见,可伴肺外症状。影像学可为间质或实质改变;更昔洛韦治疗安全有效。

Objective To investigate the clinical characteristics of cytomegalovirus（CMV） pneumonia in immunocompetent infants. Methods Analyze the clinical datas of 10 infants with CMV pneumonia was diagnosed by CMV-DNA quantitative detection in bronchoalveolar lavage fluid plus CMV-Ig M detection by ELISA, and cases co-infection with other pathogens were excluded. Results Thirteen cases were recruited, 8 cases were male, 10 cases aged ranged from 1 to 3 months, 7 cases have a course more than two weeks on admission. All had cough; 76.9% cases had tachypnea; 61.5% cases had wheezing; 23% cases had cyanosis and 30.8% cases had fever 92.3% cases had rales. Some cases had liver function and audition damage. The lymphocytes were increased, CRP were normal in 84.6% cases.There was no child with jaundice, hepatosplenomegaly, rash or malnutrition. The chest Computed Tomography showing consolidation in 4 cases and interstitial lesions in 6 cases and mixed in 3 cases. Except one treated with immunoglobulin, 12 cases treated with Ganciclovir in different course, all alleviated the symptom and lesions in X-ray. Only one case had reversible neutropenia during treat. Conclusiononclusion CMV pneumonia in immunocompetent infants had long course of cough, probably accompany with wheezing and tachypnea and might had damage in other systems. The X-ray showing could be consolidation or interstitial lesions. The Ganciclovir is safe and effective for CMV pneumonia.