儿童腺病毒肺炎541例临床特点分析

Clinical feature analysis of 541 children with adenovirus pneumonia

目的总结儿童腺病毒(HAdVs)肺炎的临床特点。方法对2017年1月至2019年8月深圳市儿童医院收治的541例HAdVs肺炎患儿的临床表现、实验室检查、影像学特点和诊治情况进行回顾性研究。结果儿童HAdVs肺炎有逐年增高趋势,541例HAdVs肺炎患儿中男327例,女214例,年龄中位数为2岁7个月,6岁以下占89.3%(483/541例)。98.3%(532/541例)的患儿有咳嗽,其次是发热(93.7%,507/541例)、气促(36.6%,198/541例)和喘息(32.5%,176/541例)。13.3%(72/541例)患儿有基础疾病,重症HAdVs肺炎占33.8%(183/541例),最常见的肺内并发症为胸腔积液(18.6%,101/541例)和呼吸衰竭(7.0%,38/541例)。在混合感染病例中,最常见的病原体为肺炎支原体(46.9%,254/541例)和细菌(21.6%,117/541例)。98.5%(533/541例)的患儿好转出院,1.5%(8/541例)的患儿死亡或自动出院。惊厥[P=0.026,OR=7.312(95%CI:1.267~42.191)]及细菌混合感染[P=0.030,OR=2.724(95%CI:1.101~6.741)]与重症HAdVs肺炎的发生具有独立相关性。结论HAdVs肺炎在学龄前期儿童多见,主要以高热及咳嗽为首发症状就诊,气促及喘息在病程中较常见,约1/3的患儿会发展成重症肺炎,惊厥及细菌混合感染与重症肺炎的发生有密切相关性。

Objective To summarize the clinical characteristics of adenovirus(HAdVs)pneumonia in children.Methods The clinical manifestations,laboratory results,imaging features and treatment courses of 541 children with HAdVs pneumonia treated in Shenzhen Children′s Hospital from January 2017 to August 2019 were retrospectively studied.Results The number of children diagnosed with HAdVs pneumonia increased year by year.A total of 541 patients were included in this study(214 females and 327 males,median age 31 months).The majority of patients(89.3%,483/541 cases)were less than 6 years of age.Cough(98.3%,532/541 cases)was the most common symptom,followed by fever(93.7%,507/541 cases),tachypnea(36.6%,198/541 cases)and wheeting(32.5%,176/541 cases).Thirteen point three percent patients(72/541 cases)had existing primary diseases.Severe HAdVs pneumonia was observed in 33.8%of patients(183/541 cases),the most common intrapulmonary complication were pleural effusion(18.6%,101/541 cases)and respiratory failure(7.0%,38/541 cases).In co-infection cases,46.9%of the patients(254/541 cases)suffered from co-infection with mycoplasma pneumoniae,21.6%of the patients(117/541 cases)suffered from bacterial co-infection.Ninety-eight point five percent of the patients(533/541 cases)were cured,and 1.5%of the patients(8/541 cases)died or discharged voluntarily.Convulsions[P=0.026,OR=7.312(95%CI:1.267-42.191)]and bacterial co-infections[P=0.030,OR=2.724(95%CI:1.101-6.741)]were independently correlated with the occurrence of severe HAdVs pneumonia.Conclusions Pre-school aged children are at higher risks of developing HAdVs pneumonia.The majority of patients presents with fever and cough as primary manifestations.Tachypnea and wheezing are also common clinical features of HAdVs pneumonia patients.Approximately a third of children with HAdVs pneumonia may develop into severe pneumonia.The presentation of convulsion and the exis-tence of bacterial co-infections may help to predict the development of severe HAdVs pneumonia in pediatric patients.