免疫功能正常婴儿巨细胞病毒肺炎临床分析

Clinical analysis of cytomegalovirus pneumonia of infants with normal immune function

目的探讨免疫功能正常婴儿巨细胞病毒(CMV)肺炎的临床特征及抗病毒治疗的必要性。方法回顾性分析20例CMV肺炎的临床特征、治疗方案及预后。结果20例CMV肺炎中,男性占17例(85.0%),低月龄(1~3月)占15例(75.0%);18例无发热(90.0%),均有咳嗽,气促13例(65.0%);均有肺部啰音;血清CMV-IgM阳性11例(55.0%),明确合并肺部细菌感染10例(50.0%),肺泡灌洗液中性粒细胞比例升高19例(95.0%),肺部高分辨率CT提示渗出、实变或磨玻璃样改变17例(85.0%);17例(16例非危重症)未抗病毒,3例加更昔洛韦抗病毒治疗,20例均治愈。结论免疫功能正常婴儿CMV肺炎存在一定的临床特异性,有助于鉴别诊断;非危重症病例可能不必常规抗病毒治疗。

Objective To investigate the clinical features of cytomegalovirus(CMV)pneumonia of infants with normal immunity function and to study the necessity treatment of antiviral therapy.Methods Clinical features,treatment and prognosis were analyzed retrospectively for 20 infant patients who diagnosed as CMV pneumonia.Results 17 cases of CMV pneumonia were male out of 20 cases(male proportion rate of 85%),and 15 cases aged from 1-3 months(monthly age rate of 75%).18 cases were found non-fever syndrome(non-fever rate of 90%).All 20 cases occurred syndrome of cough,and 13 cases with signs of short breath,20 cases with sighs of lung rales.Positive results of serum CMV-IgM were found on 11 cases(55%),pulmonary bacterial infection were found on 10 cases(50%),high proportion rate of neutrophil granulocyte in bronchoalveolar lavage fluid were found on 19 cases(95%),and exudation,consolidation or ground-glass change showed on pulmonary CT with high resolution image were found on 17 cases(85%).17 cases including 16 cases of non-crisis were not treated with antiviral therapy,the rest 3 cases were treated with antiviral therapy of Ganciclovir,and all 20 cases were cured well finally.Conclusion CMV pneumonia infant whose immunity functions are normal are found with some clinical specific features,which is helpful for differential diagnosis.Antiviral therapy is not necessity treatment for the cases of non-crisis.