儿童重症腺病毒肺炎临床特征及危险因素分析

Analysis of clinical characteristics and risk factors of severe adenovirus pneumonia in children

目的了解儿童重症腺病毒(ADV)肺炎流行病学、临床特点,及发生相关危险因素,为针对性地预防和治疗提供依据。方法回顾性分析2011年1月至2020年12月苏州大学附属儿童医院腺病毒肺炎患儿病例资料,根据疾病严重程度分为重症ADV肺炎组和普通ADV肺炎组,比较两组流行病学和临床特征,并分析重症ADV肺炎发生的危险因素。结果1158例腺病毒肺炎患儿中重症ADV肺炎组104例(8.98%),普通ADV肺炎组1054例(91.02%)。重症ADV肺炎患儿77.89%(81/104)小于3岁,中位年龄1.17(0.83,2.73)岁,显著低于普通ADV肺炎组的3.16(1.50,4.50)岁(P<0.05);重症ADV肺炎以冬春季发生为主,占全年病例的71.15%(74/104)。重症ADV肺炎组89.42%(93/104)有咳嗽,99.01%(103/104)发热,发热时间10(6,14)d显著高于普通ADV肺炎组的5(4,7)d;发生气促、喘息、抽搐/昏迷的比例显著高于普通ADV肺炎组[100%比2.09%、45.19%比13.57%、10.57%比1.99%,均P<0.05];重症ADV肺炎组出现胸腔积液、肺气肿、肺实变、肺不张病例,均显著高于普通ADV肺炎组[21.15%比2.09%、5.77%比0.19%、4.81%比0、3.85%比0.09%,均P<0.05]。多因素Logistic回归分析显示:年龄、喘息、有基础疾病(中重度贫血、先天性心脏病、神经系统疾病)是重症ADV肺炎发生的危险因素(P<0.05),受试者工作特征曲线分析显示年龄<1.71岁(20月龄)预测重症ADV肺炎发生的敏感度65.4%,特异度71.5%。结论苏州地区重症ADV肺炎多见于3岁以下患儿,好发于冬春季,以发热、咳嗽、气促、喘息为主要症状,可出现胸腔积液、肺气肿、肺实变、肺不张等肺部表现;患儿有基础疾病、喘息、发病年龄小于1.71岁(20月龄)是重症ADV肺炎发生的独立危险因素。

Objective To understand the epidemiology,clinical characteristics and associated risk factors of severe adenovirus(ADV)pneumonia in children,providing the basis for targeted prevention and treatment.Methods Clinical features of children with ADV pneumonia at Children′s Hospital of Soochow University from January 2011 to December 2020 were retrospectively analyzed.According to the severity of the disease,cases were divided into severe ADV pneumonia group and common ADV pneumonia group.The epidemiological and clinical characteristics of two groups were compared,and risk factors for the occurrence of severe ADV pneumonia were analyzed.Results A total of 1158 patients with ADV pneumonia were enrolled,including severe ADV pneumonia 104 cases(8.98%)and ordinary ADV pneumonia 1054 cases(91.02%).The median age of severe ADV pneumonia group was 1.17(0.83,2.73)years,which was significantly younger than that of common ADV pneumonia group 3.16(1.50,4.50)years(P<0.05),and 77.89%(81/104)of them were younger than 3 years old.The occurrence of severe ADV pneumonia was predominant in winter and spring,accounting for 71.15%(74/104).Cough was present in 89.42%(93/104)and fever in 99.01%(103/104)of the severe ADV pneumonia group.Compared with the common ADV pneumonia group,the severe ADV pneumonia group had a significantly longer febrile time[10(6,14)d vs.5(4,7)d,P<0.05],significantly higher incidence of shortness of breath,wheezing,convulsions/coma[100%vs.2.09%,45.19%vs.13.57%,10.57%vs.1.99%,P<0.05],and significantly higher incidences of emphysema,pleural effusion,bronchial signs,pulmonary solids,and atelectasis[21.15%vs.2.09%,5.77%vs.0.19%,4.81%vs.0,3.85%vs.0.09%,P<0.05].Multivariable Logistic regression showed that age younger than 1.71 years old,wheezing,and the presence of underlying diseases(moderate to severe anaemia,congenital heart disease,neurological disease)were risk factors for the development of severe ADV pneumonia(P<0.05).Receiver operating characteristic curve analysis showed that the sensitivity and specificity of age<1.71 years old(20 months old)for predicting the occurrence of severe ADV pneumonia were 65.4%and 71.5%,respectively.Conclusion The age of most severe ADV pneumonia is less 3 years in Suzhou.It usually occurres in winter and spring,with fever,cough,shortness of breath,and wheezing as the main symptoms.Pulmonary manifestations such as pleural effusion,emphysema,pulmonary consolidation,and atelectasis may occur.The underlying disease,wheezing,and age of onset less than 1.71 years(20 months)old are independent risk factors for severe ADV pneumonia.