重症腺病毒感染合并噬血细胞综合征7例诊治分析

Diagnosis and treatment of severe adenovirus infection with hemophagocytic syndrome in 7 cases

目的探讨重症腺病毒感染合并噬血细胞综合征(HLH)的临床特点及预后。方法收集并分析2018年1月至2019年12月收治的7例确诊为重症腺病毒感染合并HLH患儿的临床资料。结果7例患儿中男4例、女3例,3~16月龄,入院早期多次鼻咽拭子、支气管灌洗液检测呼吸道腺病毒抗原阳性。7例患儿均有咳嗽、高热,轻中度肝脾肿大;4例出现呼吸衰竭,2例并发皮下气肿及纵隔气肿。均诊断为重症肺炎;2例在入院1周内诊断为HLH;4例在入院7~14天诊断为HLH,1例在入院26天诊断为HLH。结论重症腺病毒感染好发于2岁以下婴幼儿,发热1周以上的全血细胞减少、不同程度的白蛋白下降、铁蛋白升高、乳酸脱氢酶升高、肝酶升高为重症腺病毒感染合并噬血细胞综合征的早期检测阳性指标。

Objective To explore the clinical characteristics and prognosis of severe adenovirus infection with hemophagocytic lymphohistiocytosis(HLH).Method The clinical data of severe adenovirus infection combined with HLH in 7 children from January 2018 to December 2019 were collected and analyzed.Results Among the 7 cases(4 males and 3 females)aged from 3 months to 16 months,the nasopharyngeal swabs and bronchoalveolar lavage fluid were positive multiple times for respiratory adenovirus antigens in the early stage of admission.All the 7 children had cough,high fever,and mild to moderate hepatosplenomegaly.Four had respiratory failure.Two had subcutaneous emphysema and mediastinal emphysema.All of the children were diagnosed with severe pneumonia.Two cases were diagnosed with HLH within one week of admission.Four cases were diagnosed with HLH within 7~14 days of admission and one case was diagnosed with HLH within 26 days of admission.Conclusions Severe adenovirus infections are more common in infants and children under 2 years of age.If the child has fever for more than 1 week,that pancytopenia,varying degrees of albumin decrease,ferritin increase,lactate dehydrogenase increase,and liver enzyme increase occur at the same time,is positive indicators for early detection of severe adenovirus infection with HLH.