2012至2018年我国成人腺病毒7型和55型感染临床特征比较研究

Comparative study of clinical characteristics between adult patients with adenovirus type 7 and type 55 infections in China during 2012-2018

目的比较分析成人腺病毒7型和55型感染临床特征的差异,为临床诊疗提供依据。方法回顾性分析2012年至2018年收集的214例腺病毒7型和235例腺病毒55型感染患者的临床表现、实验室检查、胸部计算机断层显像、预后资料,并分组进行比较。计数资料使用卡方检验,呈非正态分布的计量资料采用秩和检验。结果腺病毒7型组与腺病毒55型组相比腹泻[12.1%(26/214)比2.6%(6/235),χ^2=15.583]、咽后壁淋巴滤泡增生[33.2%(71/214)比17.9%(42/235),χ^2=23.566]、扁桃体肿大[56.5%(121/214)比20.0%(47/235),χ^2=63.870]伴分泌物[33.2%(71/214)比11.5%(27/235),χ^2=30.878]、白细胞计数升高[24.8%(53/214)比14.0%(33/235),χ^2=8.318]、单核细胞比例升高[78.0%(167/214)比52.8%(124/235),χ^2=31.364]、血小板计数升高[7.1%(15/212)比3.8%(9/235),χ^2=5.835]、C反应蛋白升高[80.8%(97/120)比64.3%(137/213),χ^2=10.020],以及ALT升高[13.5%(28/207)比5.6%(13/232),χ^2=8.111]、肌酸激酶升高[37.6%(77/205)比26.4%(61/231),χ^2=6.246]、CK-MB升高[35.6%(73/205)比11.1%(24/216),χ^2=35.600]的比例更多,差异均有统计学意义(均P<0.05或0.01)。与腺病毒7型组相比,腺病毒55型组病程[7(5)d比6(5)d,Z=-2.632]更长,咽痛[72.8%(17/235)比62.1%(133/214),χ^2=5.744]、头痛[62.1%(146/235)比16.4%(35/214),χ^2=97.527]、咽充血[93.6%(220/235)比74.8%(160/214),χ^2=30.602]、白细胞计数降低[14.0%(33/235)比24.8%(53/214),χ^2=8.318)、乳酸脱氢酶升高者[12.6%(29/230)比6.3%(13/205),χ^2=4.881]、影像学提示肺炎[71.5%(168/235)比31.8%(68/214),χ^2=70.850]比例更高,差异均有统计学意义(均P<0.05或0.01)。结论成人腺病毒7型和55型感染临床特征具有一定的差异,55型更易发展为肺炎,7型组织嗜性更广。

Objective To compare and explore the differences of clinical characteristics between human adenovirus type 7(HAdV7)and type 55(HAdV55)infections in adults,and to provide evidences for clinical management.Methods The data of clinical manifestations,laboratory examinations,chest computed tomography and prognosis of 214 cases with HAdV7 and 235 cases with HAdV55 infections from 2012 to 2018 were retrospectively collected and analyzed.The chi-square test was used for the categorical variables,and the rank sum test was used for the continuous variables of non-normal distribution.Results Compared with patients in HAdV55,those in HAdV7 group displayed more diarrhea(12.1%[26/214]vs 2.6%[6/235],χ^2=15.583),more laryngeal lymphatic follicles(33.2%[71/214]vs 17.9%[42/235],χ^2=23.566),more tonsil enlargement(56.5%[121/214]vs 20.0%[47/235],χ^2=63.870)with secretions(33.2%[71/214]vs 11.5%[27/235],χ^2=30.878),more leukocytosis(24.8%[53/214]vs 14.0%[33/235],χ^2=8.318),more monocytosis(78.0%[167/214]vs 52.8%[124/235],χ^2=31.364),more thrombocytosis(7.1%[15/212]vs 3.8%[9/235],χ^2=5.835),more elevated level of C-reactive protein(80.8%[97/120]vs 64.3%[137/213],χ^2=10.020),more abnormalities of liver function(alamne aminotransferase[ALT]:13.5%[28/207]vs 5.6%[13/232],χ^2=8.111)and myocardial enzymes(creatine kinase[CK]:37.6%[77/205]vs 26.4%[61/231],χ^2=6.246),creatine kinase isoenzymes([CK-MB]:35.6%[73/205]vs 11.1%[24/216],χ^2=35.600),and all the differences were statistically significant(all P<0.05,0.01).Compared with patients in HAdV7 group,those in HAdV55 group displayed longer duration of diseases(7[5]days vs 6[5]days,Z=-2.632),more sore throat(72.8%[171/235]vs 62.1%[133/214],χ^2=0.016),more headache(62.1%[146/235]vs 16.4%[35/214],χ^2=97.527),more pharyngeal congestion(93.6%[220/235]vs 74.8%[160/214],χ^2=30.602),more leukopenia(14.0%[33/235]vs 24.8%[53/214],χ^2=8.318),and more elevated level of lactate dehydrogenase(12.6%[29/230]vs 6.3%[13/205],χ^2=4.881),more pneumonia(71.5%[168/235]vs 31.8%[68/214],χ^2=70.846)(all P<0.05,0.01).Conclusions The clinical characteristics of HAdV7 and HAdV55 infections in adults are different.The type 55 infection is more likely to develop to pneumonia,while the type 7 infection has wider tissue tropism.