1046例儿童腺病毒肺炎临床特点

Clinical characteristics of 1046 children with adenovirus pneumonia

目的总结儿童腺病毒肺炎的临床特点。方法回顾性分析2010年至2019年在江西省儿童医院住院的1046例腺病毒肺炎患儿的临床资料,按照疾病严重程度分为重症组和非重症组,比较两组相关资料。结果儿童腺病毒肺炎男女比例1.5∶1;以6个月~<2岁(494例,47.2%)多见;189例(18.1%)有基础疾病;重症705例(67.4%),1024例(97.9%)患儿有发热,883例(84.4%)热峰≥39℃,747例(71.4%)热程≥7 d;846例(80.9%)有咳嗽,784例(75.0%)有气喘;930例(88.9%)肺部可闻及湿啰音,795例(76.0%)可闻及喘鸣音;550例(52.6%)白细胞计数(WBC)>12×109/L;435例(41.6%)C反应蛋白(CRP)>20 mg/L;49.0%(348/710)患儿降钙素原>0.5 ng/mL;胸部影像学多见肺实变;98.6%(218/221)支气管镜下改变提示支气管内膜炎;542例(51.8%)予激素治疗,662例(63.3%)予免疫球蛋白治疗,486例(46.5%)使用机械通气。治愈好转率为92.1%,156例(14.9%)出现后遗症,149例(14.2%)为闭塞性细支气管炎。结论腺病毒肺炎临床表现重,治疗无效率及后遗症发生率高。

Objective To summarize the clinical characteristics of adenovirus(ADV)pneumonia in children.Methods A retrospective analysis was performed on the general data,symptoms,signs,auxiliary examination,treatment and prognosis of 1046 children with ADV pneumonia hospitalized in Jiangxi Children's Hospital from 2010 to 2019.They were divided into severe ADV pneumonia group(n=705,67.4%)and non-serious ADV pneumonia group(n=341,32.6%)according to the severity of the disease.The above clinical data were compared between two groups.Results The ratio of male to female was 1.5 to 1.The children aged 6 months to 2 years accounted for 47.2%.There were 189 cases(18.1%)with underlying diseases,1024 cases(97.9%)with fever,883 cases(84.4%)with fever peak of more than 39℃,747(71.4%)cases with heat duration of more than 7 days,846(80.9%)cases with cough and 784(75.0%)cases with asthma.Moist rale was audible in 930 cases(88.9%),and wheezing was audible in 795 cases(76.0%).There were 550 cases(52.6%)with white blood cell counts(WBC)of more than 12×109/L,435 cases(41.6%)with C-reaction protein(CRP)concentration of more than 20 mg/L and 348 cases(49.0%)with procalcitonin level more than 0.5 ng/mL among 710 children receiving serum procalcitonin test.Chest X-ray showed pulmonary consolidation in most patients.Bronchoscopy findings suggested endobronchial inflammation in 218 cases(98.6%)among 221 children undergoing bronchoscopy.The hormone therapy was given in 542 cases(51.8%),662 cases(63.3%)received immunoglobulin therapy,and 486 cases(46.5%)received mechanical ventilation.The cure and improvement rate was 92.1%,the sequelae occurred in 156 cases(14.9%),and 149 cases(14.2%)had bronchiolitis obliterans.In severe ADV pneumonia group,the proportion of patients of male,from rural area,with hospital acquired infection and fever and the levels of CRP and alanine aminotransferase(ALT)were significantly higher than those in non-severe group(P<0.05).Conclusion The children with adenovirus pneumonia have severe clinical manifestations,with high inefficiency and the incidence of sequelae.