儿童腺病毒肺炎的临床特征分析

Clinical features of adenovirus pneumonia in children

目的总结分析腺病毒(ADV)肺炎患儿的临床特点,为早期准确治疗提供依据。方法回顾性分析2019年10月1日至12月31日期间在西安市儿童医院确诊的32例ADV肺炎患儿的临床资料,根据临床特征分为轻症组(n=11)与重症组(n=21),对两组的临床特征进行比较分析。结果在32例患儿中,平均年龄为(3.84±2.36)岁;病程中均有发热,平均体温峰值为(39.95±0.76)℃,热程多在1~2周;除伴有咳嗽、气喘等症状外,重症组还出现胸腔积液、心力衰竭、呼吸衰竭等多种危重并发症。与轻症组相比,重症组胸部CT以双侧肺野受累为主(χ^(2)=13.052,P<0.05);9例合并胸腔积液患儿均为重症组(χ^(2)=6.125,P<0.05)。重症组中4例ADV-7型患儿平均体温峰值为(40.65±1.03)℃,主要表现为明显烦躁不安、精神萎靡、口唇或颜面发绀、肺部可闻及不同程度肺喘鸣、三凹征阳性,均合并心肌损害、肝功能异常,且有1例并发感染中毒性脑病;影像学检查均提示累及双侧肺野,伴有不同程度的胸腔积液,临床症状及各项指标均较1例ADV-3型病情重。重症组患儿外周血中性粒细胞计数(NEU)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)均高于轻症组(t值分别为-2.085、-2.063、-2.616,P<0.05);而白细胞计数(WBC)在两组中差异无统计学意义(P>0.05)。给予患儿抗病毒治疗,部分联合甲泼尼龙抗炎、丙种球蛋白支持等治疗,所有患儿好转或临床治愈出院。结论 ADV肺炎临床表现多较重,且可伴严重并发症,结合临床特征、影像学检查及病毒分型等有利于协助评估病情程度。

Objective To summarize and analyze the clinical features of children with adenoviral(ADV) pneumonia, and provide basis for early and accurate treatment.Methods The clinical data of 32 children with ADV pneumonia diagnosed in Xi′an children′s hospital from October 1 st to December 31 st, 2019 was analyzed retrospectively.According to clinical features, patients were divided into the mild group(n=11) and severe group(n=21).The clinical features of the two groups were compared and analyzed.Results The average age of 32 children was(3.84±2.36) years, and children all had fever in the course of disease, with an average peak value of(39.95±0.76)℃,and the hot course was mostly about 1-2 weeks.In addition to symptoms such as cough and wheezing, the severe group also had pleural effusion and heart failure, respiratory failure and other critical complications.Compared with the mild group, chest CT in the severe group mainly involved bilateral lung(χ^(2)=13.052,P<0.05).Nine patients with pleural effusion were all children in the severe group(χ^(2)=6.125,P<0.05).In the severe group, the average peak temperature of four patients with ADV-7 was(40.65±1.03) ℃,which mainly showed obvious dysphoria, listlessness, cyanosis of lips or face, audible varying degrees of lung wheezing in the lungs, and positive three concave signs, all with myocardial damage, abnormal liver function, and one case complicated with toxic encephalopathy.Imaging examination showed that bilateral lungs were involved, accompanied by varying degrees of pleural effusion, the clinical symptoms and various indicators were more severe than those of ADV-3.The neutrophil count, C-reactive protein and lactate dehydrogenase in the peripheral blood of children in the severe group were higher than those in the mild group(t=-2.085,-2.063 and-2.616,respectively, P<0.05).There was no significant difference in white blood cell count between the two groups(P>0.05).All patients were treated with antiviral therapy, and some patients were treated with methylprednisolone anti-inflammatory therapy and gamma globulin support.All patients were improved or cured and discharged from hospital.Conclusion The clinical manifestations of ADV pneumonia are often severe and may be accompanied by serious complications.The combination of clinical features, imaging examination and virus typing can help to evaluate the severity of the disease.