不同载量人博卡病毒肺炎患儿临床特征及肺功能分析

Analysis of Clinical Characteristics and Pulmonary Function of Children with Human Bocavirus Pneumonia

目的:比较不同载量人博卡病毒(HBo V)肺炎患儿的临床特征及肺功能指标,了解HBo V载量与肺炎的关系,探讨HBo V致病机制。方法:选取2013年1-11月因支气管肺炎在苏州大学附属儿童医院呼吸科住院治疗的婴幼儿1 653例,应用荧光定量PCR法检测患儿痰液中HBo V-DNA,检出HBo V阳性患儿122例,其中高病毒载量组(HBo V-DNA≥1×104copies/m L)65例,低病毒载量组(HBo V-DNA<1×104copies/m L)57例,比较两组患儿的临床特征;高载量组36例、低载量组28例进行肺功能检测,观测患儿潮气呼吸流速-容量环(TBFV环)形态及其各项指标变化。结果:不同HBo V载量感染组间临床症状比较,除喘息外,其他症状发生率差异均无统计学意义。但肺功能比较,高病毒载量组与低病毒载量组到达峰流速时间(TPTEF)、到达峰流速时呼出气量(VPTEF)及反映小气道功能指标到达峰流速时间/呼气时间(TPTEF/TE)、到达峰流速时呼出气量/呼气容积(VPTEF/VE)、剩余25%潮气量时呼气流速(TEF 25%)及剩余25%潮气量时的呼气流速/呼气峰速(TEF 25%/PF)均明显降低,且高病毒载量组上述值下降更明显,差异均有统计学意义(P<0.05);高、低病毒载量组中代表大气道功能的指标平均呼气流速/平均吸气流速(ME/MI)与正常对照组比较差异均无统计学意义。从TBFV环形态上看,HBo V肺炎患儿呼气峰左移,呼气相降支呈波谷样凹陷,且高病毒载量组凹陷更加明显。结论:苏州地区HBo V肺炎住院患儿存在一定的肺功能损害,主要表现为小气道阻塞性功能障碍。病毒载量与临床症状及肺功能损害程度相关,高载量组喘息发作率高,小气道损害明显。

Objective： To compare the pulmonary function and clinical characteristics in children with human Bocavirus（ HBo V）pneumonia,understand the relationship between HBo V load and pneumonia,and investigate the pathogenic mechanism. Methods： A total of 1,653 children who were diagnosed with bronchial pneumonia in Children＇s Hospital Affiliated to Suzhou University from January to November,2013 were selected. HBo V-DNA in sputum was detected by fluorescence quantitative PCR method. One hundred and twenty two children with positive-HBo V were divided into the high viral load group（ 65 cases） and low viral load group（ 57 cases）. The clinical characteristics of the two groups were compared. The pulmonary function,the shape of tidal breathing flow-volume loops and changes of every index were observed in the high viral load group（ 36 cases） and low viral load group（ 28 cases）. Results： There were no differences in the clinical symptoms in the high viral load group and low viral load group,except the incidence of asthma. The TPTEF,VPTEF,TPTEF / TE,VPTEF / VE,the ratio of TEF 25% to PTEF in the high viral load group and low viral load group were significantly decreased compared with normal control group,but the decrease in high viral load group were more obvious（ P 0. 05）.ME / MI in the high viral load group and low viral load group showed no significant differences compared with normal control group.During acute phase of HBo V infection with high or low viral load,wave crest of TBFVLs moved left and the declined limb became troughlike concave,and the change in high viral load group was more obvious. Coclusion： Whatever the hospitalized infants infected with high or low viral load of HBo V in Suzhou,their lung function damaged in dysfunction of small airway obstruction. More severe impairment of pulmonary function and high incidence of wheezing in infants are infected with the high viral load of HBo V.