成人重症腺病毒肺炎临床研究

Clinical features of severe adenovirus pneumonia in adults

目的分析重症腺病毒肺炎患者的临床特征,确定成人重症腺病毒肺炎的早期评估方法。方法回顾性分析24例7型腺病毒呼吸道感染致重症腺病毒肺炎患者的临床资料,总结咳嗽评分、咳嗽时间、影像资料、生化指标及并发症,并就以上指标与42例轻症患者进行比较。结果 24例重症腺病毒肺炎患者危重症评分为(69.75±8.24)分,表现高热和剧烈咳嗽,发热持续时间12~24(16.21±6.54)d。66例中生命体征异常和低氧血症28例,胸部CT示叶、段性的实变伴毛玻璃影29例,影像学上进展多表现为大片实变为主的病灶,可出现范围迅速扩大、密度增高和多种不同形态的新发病灶,入院白细胞计数、中性粒细胞增高25例,血小板计数减少5例(血小板计数重症组与轻症组比较,P<0.05)。结论持续高热并咳嗽评分>2分,胸部CT出现大片实变和迅速进展为大叶性病灶,氧合指数降低,血小板减少,肝功能异常,是成人腺病毒肺炎向重症发展早期的主要特点。

Objective To observe the clinical manifestations of 24 patients with severe adenovirus pneumonia（ SAd VP） in order to achieve early recognition of the severe type of the disease.Methods Clinical data of 24 cases with SAd VP caused by respiratory serotype 7 adenovirus infection,such as clinical features,image data,biochemical indicator and complications were analyzed retrospectively,and compared with 42 mild pneumonia cases. Results Twenty-four cases were the first batch patients admitted to our hospital after the outbreak of epidemic with pneumonia severity index（ PSI） of 69. 75±8. 24. Compared with mild cases,severe cases had higher fever with a temperature reaching and severe cough.The duration of high fever was range 12 ~ 24 days. Abnormal vital signs,hypoxemia occured in 28 cases. In 29 severe cases,CT showed lobar or segmental consolidation with ground glassopacity（ GGO）. Progression of chest CT manifested as extension and newly emerging of multi-shaped lesions which characterized by a large range of GGO damage. In admission,leukocytosis and elevation of neutrophils in 25 cases,thrombocytopnea in 5 cases compared with those of mild cases（ P 〈0. 05）. Conclusion Persistent hyperpyrexia and severe cough,lobar lesions and large areas of GGO in chest CT,decreased oxygenation index,thrombocytopenia and abnormal liver function are main features before deterioration of patients suffering from adenovirus pneumonia.