婴儿巨细胞病毒肺炎的诊治分析

The Effect of Bronchoalveolar Lavage on the Diagnoses and Treatment of Cytomegalovirus Pneumonia in Infant Patients

目的探讨支气管肺泡灌洗对婴儿巨细胞病毒肺炎的诊断及治疗作用。方法选取2016年1月—2019年6月于本院儿科病房住院的年龄1个月~1岁、血清CMV-IgM/IgG(CMV:cytomegalovirus,巨细胞病毒)抗体阳性或血清CMV-DNA检测阳性,且排除合并感染,确诊为CMV肺炎的患儿共45例,行支气管肺泡灌洗的22例患儿为观察组,未行支气管肺泡灌洗的23例患儿为对照组,将两组临床资料进行分析及随访。结果观察组肺泡灌洗液CMV-DNA阳性率95.5%,其中有21例患儿予更昔洛韦治疗,1例未用,仅予丙种球蛋白,12例显效,9例有效,总有效率95.5%,治疗后临床症状减轻平均时间(7.85±2.12)天;对照组中有21例患儿予更昔洛韦治疗,2例未用,仅予丙种球蛋白,12例显效,9例有效,总有效率91.3%,临床症状减轻平均时间(9.75±3.56)天,两组症状减轻时间比较有统计学意义(P<0.05),总有效率无统计学差异。结论支气管肺泡灌洗液CMV-DNA阳性率高,对疑诊CMV肺炎患儿及时行支气管肺泡灌洗有助于尽早诊断及改善临床症状。

Objective To study the effect of bronchoalveolar lavage on the diagnoses and treatment of cytomegalovirus pneumonia in infant patients.Methods We selected 45 patients with pneumonia,1 to 12 months,with positive serum CMV-IgM/IgG or positive serum CMV-DNA quantitation from January,2016 to June,2019.Twenty two of them who underwent bronchoalveolar lavage were considered as the study group,the other twenty three who didn’t were considered as the control group.The clinical data were compared between the two groups.Results The positive rate of CMV-DNA in the alveolar lavage fluid of the study group was 95.5%.21 patients were treated with ganciclovir,1 patient used immunoglobulin only.The total effective rate of study group was 95.5%.The average time of clinical symptoms change for the better was(7.85±2.12)days.21 patients in the control group were treated with ganciclovir,2 patients used immunoglobulin only.The total effective rateand was 91.3%.The average time of clinical symptoms change for the better was(9.75±3.56)days.There was a statistically significant in the time of clinical symptoms change for the better between the two groups(P<0.05),and there was no significant difference in the cure rate.Conclusion The clinical manifestations and lung physical signs of infants with CMV pneumonia are not specific,and the lung image is not typical.The positive rate of CMVDNA in bronchoalveolar lavage fluid is high..The bronchoalveolar lavage is essential for the diagnoses and treatment of CMV pneumonia.