22例儿童重症人偏肺病毒肺炎临床特征分析

Clinical characteristics of 22 critically ill children with human metapneumovirus pneumonia

目的 探讨儿童重症偏肺病毒肺炎的临床特征。方法 选取2022年1月至2022年4月广州市妇女儿童医疗中心诊治的22例重症人偏肺病毒肺炎患儿为研究组,同期33例重症呼吸道合胞病毒肺炎患儿为对照组,回顾性收集两组患儿的一般情况、临床特征、实验室检查、影像学资料、治疗及转归进行分析比较。结果 重症hMPV肺炎患儿以男性为主,占72.7%(16/22),45.5%(10/22)患儿合并基础疾病,与RSV组患儿相比无统计学差异。中位年龄26(6.5,48)月,显著大于对照组患儿4(1,14.5)月(P=0.003)。所有重症hMPV肺炎患儿均有发热(22/22,100%),显著高于危重症RSV肺炎患儿的69.7%(23/33)(P=0.004);59%(13/22)的重症hMPV患儿出现喘息,低于RSV组患儿的87.9%(29/33)(P=0.014);咳嗽、气促、呼吸困难、声嘶、发绀、鼻塞流涕、呼吸暂停与RSV组差异无统计学意义(P均>0.05)。与重症RSV肺炎患儿相比,重症hMPV肺炎患儿CRP、PCT明显增高(P<0.05),但PaCO_(2)较RSV组患儿低(P=0.013)。54.5%(12/22)重症hMPV肺炎患儿合并细菌感染,高于RSV组患儿的24.2%(8/33)(P=0.044)。两组患儿影像学特征相仿,差异无统计学意义(P>0.05)。40.9%(9/22)患儿行纤支镜检查,均可见粘膜充血水肿明显。研究组中63.6%(14/22)患儿予抗生素治疗,较对照组30.3%(13/33)高(P=0.026);研究组所有(22/22)患儿均需机械通气,机械通气时间9(7,10)天,住PICU时间10(8.75,12.25)天,住院时长15(11.75,21.25)天,50%(11/22)使用激素治疗,77.3%(17/22)予免疫球蛋白治疗,与对照组比较差异无统计学意义。除1例放弃治疗死亡外,其余均好转出院。结论 重症hMPV肺炎,以2岁幼儿为主,以发热、咳嗽、呼吸困难、气促为主要特征,混合细菌感染多见,多预后良好。

Objective To investigate the clinical characteristics of children with severe human metapneumovirus(hMPV)pneumonia.Methods A total of 22 children with severe hMPV pneumonia diagnosed and treated in Guangzhou Women and Children's Medical Center from January 2022 to April 2022 were selected as the study group,and 33 children with severe respiratory syncytial virus pneumonia during the same period were selected as the control group.The general situation,clinical characteristics,laboratory examination,imaging data,treatment,and outcome of the two groups were retrospectively collected and compared.Results The children with severe hMPV pneumonia were mainly male,accounting for 72.7%(16/22),and 45.5%(10/22)were complicated with underlying diseases,showing no statistical difference compared with the RSV group.The median age was[26(6.5,48)]months,which was significantly older than that of children with severe RSV pneumonia[4(1,14.5)]months(P=0.003).All the children with severe hMPV pneumonia had a fever(22/22,100%),which was significantly higher than that with critical RSV pneumonia(69.7%,23/33)(P=0.004).59%(13/22)of the children with severe hMPV pneumonia had wheezing,lower than 87.9%(29/33)in the RSV group(P=0.014).Cough,shortness of breath,dyspnea,hoarseness,cyanosis,nasal congestion,and runny nose,apnea had no significant difference compared with the RSV group(P>0.05).Compared with the children with severe RSV pneumonia,CRP and PCT were significantly increased in the children with severe hMPV pneumonia(P<0.05),but PaCO_(2) was lower than that in the RSV group(P=0.013).54.5%(12/22)of the children with severe hMPV pneumonia co-infected with bacteria,which was higher than 24.2%(8/33)in the RSV group(P=0.044).The imaging features of the two groups were similar,and there was no statistical difference between the two groups(P>0.05).40.9%(9/22)of the patients underwent fiberoptic bronchoscopy,and significant mucosal hyperemia and edema were observed in all the patients.63.6%(14/22)of the study group received antibiotics,with was higher than the control group(30.3%,P=0.026).All the children in the study group needed mechanical ventilation,mechanical ventilation time for[9(7,10)]days,PICU stay for[10(8.75,12.25)]days,and hospital stay for[15(11.75,21.25)]days.50%(11/22)received hormone therapy,and 77.3%(17/22)received immunoglobulin therapy,and there was no significant difference between the two groups.One patient died due to abandonment of treatment,all the other children were discharged from the hospital.Conclusion Severe hMPV pneumonia usually occurs in children aged 2 years,and is mainly characterized by fever,cough,wheezing,and dyspnea.Bacterial co-infection is more common.The great majority of the patients have a good prognosis.