免疫功能正常儿童腺病毒肺炎发生肝功能损伤的临床特征

Clinical features of liver injury in children with adenovirus pneumonia with normal immune function

目的了解儿童腺病毒肺炎伴肝功能异常患儿的临床特征提高临床医生对腺病毒肺炎合并肝功能损伤的认识。方法回顾性收集2013年1月1日至2020年12月31日儿童社区获得性腺病毒肺炎3294例临床资料,分析肝功能正常组以及肝功能异常组临床特征和相关实验室检查结果,应用多变量回归分析方法分析相关因素。结果1704例纳入患儿在入院时实验室检查提示谷丙转氨酶和/或谷草转氨酶升高,肝功能损伤率(51.7%,1704/3294)。轻度损伤1671例(98.1%,1671/1704)、中度损伤28例(1.64%,28/1704)、重度损伤5例(0.29%,5/1704)。肝功能正常组与肝功能异常组进行单因素比较,肝功能异常组男性患儿比例高于肝功能正常组(68.1%,64.2%,P=0.017),且年龄较小[16(9,30)月,38(19,53)月,P<0.001]。肝功能异常组患儿更容易出现喘息(32.9%,18.7%,P<0.001)、气促(13.7%,9.1%,P<0.001)和腹泻(11.0%,4.7%,P<0.001)。实验室检查结果显示肝功能异常组患儿白细胞计数、中性粒细胞计数及血红蛋白低于正常组,淋巴细胞则高于正常组,肌酸激酶、心型肌酸激酶和乳酸脱氢酶水平较高。肝功能异常组患儿发生重症肺炎的比例(26.9%,11.2%,P<0.001)高于肝功能正常的患者,病死率明显较高(1.47%,0.25%,P<0.001)。对轻症及重症腺病毒肺炎儿童肝功能损伤机率进行比较,结果发现重症肺炎组儿童发生肝损伤更为多见(73.0%,46.6%,P<0.001),且中度及重度肝损伤均高于轻症组。进一步多变量逻辑回归分析并未发现与肝损伤的发生率显著相关因素。结论儿童腺病毒肺炎伴肝功能损伤的发生率高,以轻度损伤多见。发生肝功能损伤患儿年龄较小,喘息及气促等临床症状相对更重,重症肺炎比例及病死率更高。儿童重症腺病毒肺炎发生肝损伤比例更高,中重度损伤更为常见。对伴有不同程度肝功能损伤患儿应加强监测。

Objective To study the clinical characteristics of children with adenovirus pneumonia complicated with liver injury and the understanding of clinicians.Methods The children diagnosed with community-acquired adenovirus pneumonia were enrolled from January 1,2013 to December 31,2020.The clinical characteristics of the normal liver function group and the liver injured group were compared,and multivariate regression was applied.Results Among the 3294 enrolled children,1704 children had elevated alanine aminotransferase and/or aspartate aminotransferase on admission,and the liver function impairment rate was 51.7%(1704/3294),of which 1671 cases were mildly injured(98.06%,1671/1704),28 cases were moderately injured(1.64%,28/1704),and 5 cases were severely injured(0.29%,5/1704).Compared with the normal liver function group,the proportion of male children in the liver injured group was higher(68.1%vs.64.2%,P=0.017),and the age was younger[16(9,30)months vs.38(19,53)months,P<0.001].Children with liver injury were more likely to have wheezing(32.9%vs.18.7%,P<0.001),shortness of breath(13.7%vs.9.1%,P<0.001),and diarrhea(11.0%vs.4.7%,P<0.001).The white blood cell counts,neutrophil counts and hemoglobin in the liver injured group were lower than those in the normal group,while the lymphocyte counts were higher than those in the normal group.The levels of creatine kinase,cardiac creatine kinase and lactate dehydrogenase were higher.The proportion of severe pneumonia in the liver injured group(26.9%vs.11.2%,P<0.001)was higher than that in the normal liver function group,and the case fatality rate was significantly higher(1.47%vs.0.25%,P<0.001).Comparing the probability of liver injury in children with mild and severe adenovirus pneumonia,it was found that the severe pneumonia group had more frequent liver injury(73.0%vs 46.6%,P<0.001),and both moderate and severe liver injury groups were higher than in the mild group.Further multivariate logistic regression analysis did not find a significant factor associated with the incidence of liver injury.Conclusions The incidence of adenovirus pneumonia in children with liver injury was high,and mild injury is more common.Children with liver injury were younger,had more severe clinical symptoms such as wheezing and shortness of breath,and higher proportion of severe pneumonia and mortality.Among them,children with severe pneumonia had a higher proportion of liver injury,and moderate to severe injury was more common.The monitoring of children with different degrees of liver injury should be strengthened.