2例人巨细胞病毒肺炎患儿病例报道及文献回顾

Case report and literature review of 2 children with human cytomegalovirus pneumonia

目的分析2例人巨细胞病毒(HCMV)肺炎患儿的临床特点,并结合国内外文献总结其转归的危险因素及免疫机制。方法回顾性分析西安市儿童医院呼吸二科收治的2例HCMV肺炎患儿的临床资料,观察其病情演变过程、治疗经过及转归,并查阅国内外HCMV肺炎相关文献,探索此类罕见病毒性肺炎的危险因素及其发病的免疫机制。结果HCMV肺炎患儿的影像学资料存在典型肺间质异常时,临床表现及治疗后转归的差异与患儿自身免疫功能相关。免疫功能正常的患儿,常规治疗过程顺利;但对于免疫缺陷患儿,即使在常规治疗基础上联合静脉注射用免疫球蛋白(IVIG)仍不能阻止HCMV引起的严重组织损伤及炎症反应。结论HCMV肺炎的影像学改变与病情危重程度及预后相关性较低。HCMV所引起的严重免疫反应可能存在一定的自限性,且HCMV重症感染会抑制机体免疫功能。对于免疫缺陷患儿,常规剂量IVIG治疗可能效果欠佳,治疗过程中应积极做好免疫学监测,判断疾病转归,并及时调整治疗方案,必要时可考虑再次足量IVIG治疗。

Objective To analyze the clinical characteristics of 2 children with human cytomegalovirus(HCMV)pneumonia,and summarize the risk factors and immune mechanism of its prognosis combined with the literature at home and abroad.Methods The clinical data of 2 children with HCMV pneumonia admitted in the No.2 respiratory department of Xi'an Children's Hospital were retrospectively analyzed,and the disease evolution process,treatment process and outcome were observed,and literatures at home and abroad on HCMV pneumonia were reviewed to explore the risk factors of such rare viruses pneumonia and the immune mechanism of its pathogenesis.Results When there are typical pulmonary interstitial abnormalities in the imaging data of children with HCMV pneumonia,the differences in clinical manifestations and outcomes after treatment were related to the children's autoimmune function.In children with normal immune function,the routine treatment process went smoothly;in children with immunodeficiency,even combined with intravenous immunoglobulin(IVIG)on the basis of routine treatment,the severe tissue damage and inflammatory response caused by HCMV could not be prevented.Conclusion The imaging changes of HCMV pneumonia have low correlation with the severity and prognosis of the disease.The severe immune response caused by HCMV may be self-limited to a certain extent,and severe HCMV infection will inhibit the immune function of the body.For children with immune deficiency,conventional dose IVIG treatment may be ineffective,and immunological monitoring should be actively performed during the treatment process to determine the prognosis of the disease,and adjust the treatment plan in time.If necessary,full-dose IVIG treatment can be considered again.