高效价血浆救治儿童重症腺病毒肺炎疗效探讨

Effect of high-titer plasma in pediatric patients with severe adenovirus pneumonia

目的:探讨高效价血浆救治儿童重症腺病毒肺炎的疗效及安全性。方法:回顾性收集2016年1月至2019年10月广州市妇女儿童医疗中心儿童重症监护病房(PICU)收治的92例重症腺病毒肺炎患儿的临床资料。按照是否使用高效价血浆治疗分为血浆治疗组(41例)、非血浆治疗组(51例);对胸X线片受累大于1/2的51例患儿分为血浆治疗组(29例)、非血浆治疗组(22例);根据使用高效价血浆前的发热病程,分早期组(≤5 d,5例)、中期组(>5~10 d,14例)、晚期组(>10 d,22例)。比较各组患儿基线资料、治疗效果及预后情况。组间比较采用 t检验、非参数秩和检验、单因素方差分析或χ^2检验。 结果:共纳入92例重症腺病毒肺炎患儿。血浆治疗组与非血浆治疗组患儿入组前年龄、性别、体重、发热时间、序贯器官功能衰竭评分、Murray肺损伤评分差异均无统计学意义( P均>0.05);血浆治疗组5 d内体温降至正常率高于非血浆治疗组[88%(36/41)比69%(35/51),χ^2=4.745, P=0.029];但14 d内撤离有创呼吸机率[63%(26/41)比76%(39/51)]及PICU转出率[49%(20/41)比69%(35/51)]、28 d内出院率[51%(21/41)比61%(31/51)]、存活率[85%(35/41)比76%(39/51)]差异均无统计学意义(χ^2=1.868、3.724、0.846、1.143, P=0.172、0.054、0.358、0.285)。胸X线严重受累患儿中血浆治疗组5 d内体温降至正常率、存活率高于非血浆治疗组[86%(25/29)比59%(13/22)、83%(24/29)比55%(12/22),χ^2=4.843、4.796, P=0.028、0.029];但14 d内撤离有创呼吸机率[52%(15/29)比59%(13/22)]及PICU转出率[34%(10/29)比45%(10/22)]、28 d内出院率[45%(13/29)比45%(10/22)]差异均无统计学意义(χ^2=0.274、0.632、0.002, P=0.601、0.427、0.964)。发热病程早期组、中期组、晚期组患儿14 d内撤离有创呼吸机率(或例数比)分别为2/5、13/14、50%(11/22),组间比较差异有统计学意义(χ^2=8.119, P=0.017);3组间5 d内体温降至正常率(或例数比)[4/5、14/14、82%(18/22)]、14 d内PICU转出率(或例数比)[2/5、10/14、36%(8/22)]、28 d内出院率(或例数比)[2/5、8/14、50%(11/22)]、存活率(或例数比)[4/5、13/14、82%(18/22)]差异均无统计学意义(χ^2=2.965、4.386、0.462、0.966, P=0.227、0.112、0.794、0.617);血浆治疗组患儿中只有1例在输注高效价血浆治疗过程中出现皮疹,余患儿均未见其他不良反应。 结论:高效价血浆救治儿童重症腺病毒肺炎能缩短发热时间及提高存活率;在发热病程的5~10 d应用高效价血浆临床效果更理想。高效价血浆治疗是安全可行的。

Objective To explore the efficacy and safety of high-titer plasma in the treatment of pediatric patients with severe adenovirus pneumonia.Methods The clinical data of 92 pediatric patients with severe adenovirus pneumonia admitted to pediatric intensive care unit(PICU)in Guangzhou Women and Children′s Medical Center from January 2016 to October 2019 were retrospectively collected.According to the treatment with or without high-titer plasma,the patients were divided into plasma treatment group(n=41)and non-plasma treatment group(n=51).The 51 patients with chest radiograph showing more than half the lungs involved were divided into plasma treatment group(n=29)and non-plasma treatment group(n=22).According to fever duration before plasma treatment,patients were divided into early group(≤5 days,n=5),middle group(>5-10 days,n=14),and late group(>10 days,n=22).Baseline data,therapeutic effects,and prognosis of patients in each group were analyzed with t test,non-parametric rank sum test,one-way ANOVA and chi-square test.Results Ninety-two patients were included.There were no significant differences in age,gender,body weight,fever duration,sequential organ failure assessment,and Murray lung injury score between plasma treatment group and non-plasma treatment group before admission(all P>0.05).The proportion of patients whose temperature drop to normal within 5 days was higher in plasma treatment group than that in non-plasma treatment group(88%(36/41)vs.69%(35/51),χ^2=4.745,P=0.029).However,there were no significant differences between the two groups in the proportions of invasive ventilator weaning within 14 days(63%(26/41)vs.76%(39/51),χ^2=1.868,P=0.172),transfer out from PICU within 14 days(49%(20/41)vs.69%(35/51),χ^2=3.724,P=0.054),discharge within 28 days(51%(21/41)vs.61%(31/51),χ^2=0.846,P=0.358)and survived patients(85%(35/41)vs.76%(39/51),χ^2=1.143,P=0.285).Among patients with severe chest radiograph,the proportions of patients whose temperature drop to normal within 5 days and survived patients were higher in plasma treatment group than those in non-plasma treatment group(86%(25/29)vs.59%(13/22),χ^2=4.843,P=0.028;83%(24/29)vs.55%(12/22),χ^2=4.796,P=0.029,respectively).However,there were no significant differences between the two groups in the proportions of invasive ventilator weaning within 14 days(52%(15/29)vs.59%(13/22),χ^2=0.274,P=0.601),transfer out from PICU within 14 days(34%(10/29)vs.45%(10/22),χ^2=0.632,P=0.427),and discharge within 28 days(45%(13/29)vs.45%(10/22),χ^2=0.002,P=0.964).Among early,middle and late group,the proportions of invasive ventilator weaning within 14 days were 2/5,13/14 and 50%(11/22),respectively,with statistically significant difference(χ^2=8.119,P=0.017).There were no significant differences in the proportions of patients whose temperature drop to normal within 5 days(4/5,14/14,82%(18/22),χ^2=2.965,P=0.227),transfer out from PICU within 14 days(2/5,10/14,36%(8/22),χ^2=4.386,P=0.112),discharge within 28 days(2/5,8/14,50%(11/22),χ^2=0.462,P=0.794)and survived patients(4/5,13/14,82%(18/22),χ^2=0.966,P=0.617)in the three groups.Only one case with high-titer plasma therapy had rash in the course of infusing plasma and no other adverse reactions were observed.Conclusions High-titer plasma can shorten the fever time and improve the proportion of survival patients in pediatric severe adenovirus pneumonia.The clinical effect of high-titer plasma is better in 5-10 days of fever course.High-titer plasma is an effective and safe treatment.