儿童重症腺病毒肺炎的表现特征及早期判断指标

Clinical Characteristics and Predictive Factors of Severe Adenovirus Pneumonia in Children

目的:探讨儿童重症腺病毒肺炎(SAP)的表现特征和判断指标。方法:回顾性分析124例SAP患儿的临床资料,依据病情轻重分为普通组(n=52)和重症组(n=72),比较两组临床资料,将两组差异有统计学意义的单因素作ROC曲线,寻找SAP的早期判断指标。结果:重症组住院时间、热程、LDH、AST、累及肺叶≥2个、胸腔积液比例均明显高于普通组,差异均有统计学意义(P<0.05);重症组年龄、ALB均明显小于普通组,差异均有统计学意义(P<0.05)。两组外周血WBC、NE、CRP比较,差异均无统计学意义(P>0.05)。经ROC曲线下面积计算得出年龄、热程、AST、LDH、ALB五个独立相关因素可作为重症腺病毒肺炎有价值的预测指标,界值分别为年龄3.5岁、热程6.5 d、LDH 560 U/L、AST 63.5 U/L、ALB 36.5 g/L。结论:SAP热峰高,热程长,酶学指标高,肺部病灶广泛,如不能早期识别,病死率较高。当腺病毒肺炎患儿年龄≤3.5岁、持续高热≥6.5 d、初诊时LDH≥560 U/L、AST≥63.5 U/L、ALB≤36.5 g/L,应注意SAP可能。

Objective:To investigate the clinical characteristics and predictive factors of severe adenovirus pneumonia(SAP)in children.Method:Retrospective analysis was executed on the clinical data of 124 children.The patients were divided into the common group(n=52)and the severe group(n=72)according to the severity of the disease.The clinical data of two groups were compared,ROC curve was made for the single factors with statistically significant difference between two groups,in order to seek the reference indexes of SAP.Result:Compared with the common group,the hospitalization time,fever duration,LDH,AST,the proportion of pleural effusion,and involved lobes more than 2 cases were higher in the severe group,while the age and ALB were lower,and these indicators had significantly statistical differences(P<0.05).While there were no significant differences in WBC,the percentage of neutrophils(NE)and CRP between two groups(P>0.05).In ROC curve analysis,the cut-off values for the age,fever duration,LDH,AST,ALB were set at 3.5 years old,6.5 d,560 U/L,63.5 U/L and 36.5 g/L,respectively.Conclusion:SAP has high heat peak,long heat course,high enzyme index,extensive lung lesions and high fatality when can’t be early identified.It may be SAP in some situations such as age≤3.5 years old,lasting high fever for more than 6.5 d,LDH≥560 U/L,AST≥63.5 U/L,ALB≤36.5 g/L.