不同病程阶段重症腺病毒肺炎患儿临床特征及胸部CT影像学征象分析

Clinical Features of Children with Severe Adenovirus Pneumonia at Different Stages and The Imaging Signs of Chest CT

目的分析不同病程阶段重症腺病毒肺炎患儿临床特征及胸部CT影像学征象。方法选取本院2018年2月至2019年6月收治且经实验室检查或病理确诊的44例重症腺病毒肺炎患儿作为研究对象,对比急性期、恢复期重症腺病毒肺炎临床特征及其的CT征象。结果44例患儿均有发热、咳嗽、气喘及呼吸困难等症状,90.91%患儿肺部有湿罗音,61.36%患儿肺部存在哮罗音,肝脾肥大相对少见,仅占22.73%;实验室检查示86.36%的患儿心肌酶谱升高,40.91%患儿白细胞计数升高,50.00%患儿C反应蛋白升高。急性期患儿CT扫描34例可见双肺大片多发实变影,呈向心性分布。10例可见大叶性肺实变影。24例可见少量或中量胸腔积液。恢复早期CT扫描38例可见双肺透亮度不均匀,呈“马赛克”样改变。恢复后期CT扫描示早期出现“马赛克”征的38例患儿,仅2例可见支气管扩张,CT扫描表现为单侧透明肺病变。结论重症腺病毒肺炎患儿急性期CT扫描可见大片多发实变影、大叶性实变影、支气管扩张及胸腔积液;恢复期伴肺部后遗症患儿胸部CT典型“马赛克”征可长期存在。

Objective To analyze the clinical features of children with severe adenovirus pneumonia at different stages and the imaging signs of chest CT.Methods 44 children with severe adenoviral pneumonia who were admitted to our hospital from February 2018 to June 2019 and confirmed by laboratory examination or pathology were selected as the research subjects.The clinical features and CT signs of children with severe adenovirus pneumonia in acute stage and recovery were compared.Results 44 children had symptoms of fever,cough,asthma,and dyspnea.90.91%of the children had moist rales in the lungs,61.36%children had asthma rales,and hepatosplenomegaly was relatively rare,accounting for only 22.73%.Laboratory tests showed that Myo-cardial enzymonram of 86.36%patients increased,the white blood cell count of 40.91%children increased,and C-reactive protein of 50.00%children increased.CT scans of children in the acute phase showed a large numbers of multiple consolidation shadows in both lungs in 34 patients,showing a centripetal distribution.10 cases showed large lobar consolidation shadows.24 patients showed a small or moderate amount of pleural effusion.CT scans at the early stage of recovery showed that 38 cases showed uneven transparency in both lungs,showing a"mosaic"change.CT scans at the late stage of recovery showed in 38 patients with"mosaic"signs at the early stage,only 2 cases showed bronchiectasis,CT scan showed unilateral clear lung lesions.Conclusion CT scans of children with severe adenovirus pneumonia in the acute phase can show a large number of multiple consolidation shadows,lobar consolidation shadow,bronchiectasis and pleural effusion.The typical"mosaic"sign of chest CT in children with lung sequelae in the recovery period can exist for a long time.